songlady's advice on how to get VSL#3 DS covered by insurance

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passer
Regular Member


Date Joined Dec 2007
Total Posts : 47
   Posted 1/13/2010 10:25 AM (GMT -6)   
Hi All - I think this is worth breaking out into a separate thread.

As many of you know, when 'VSL#3 Double Strength' first came out, it was prescription only. You couldn't buy it over the counter, you could only buy the regular VSL#3 (not Double Strength) over the counter at the time. While this was the case, I had zero problems getting the VSL#3 Double Strength with a prescription from my doctor.

After a while, VSL#3 Double Strength began to be offered over the counter. So the prescription only feature was taken away. When this happened, my insurance company no longer covered VSL#3 Double Strength. Since I was taking 3 packets per day, the cost for me skyrocketed.

Songlady has figured out a way to get VSL#3 Double Strength covered by her insurance company. Here's how:

songlady had tried getting the VSL#3 DS a few times by prescription, and she was rejected both times. Her doctor had written the prescription as "VSL#3 DS packets of 30". After being rejected a few times with that, songlady had her doctor write "VSL#3 DS packets of 20" instead. Switching from 'packets of 30' to 'packets of 20' worked, and her insurance company covered it!

Has anyone else tried this method with success? This might be a major breakthrough for me, because the VSL#3 DS over the counter is very expensive for the dosing I need ($18/day). Thank you songlady for uncovering this strategy!!

songlady
Veteran Member


Date Joined Aug 2009
Total Posts : 3250
   Posted 1/13/2010 3:08 PM (GMT -6)   
Well, thanks, I think.... let's see if anyone else has success or trouble getting it!

I remembered from when the DS was on the company's website that the DS was listed as boxes of 20 packets.
And I assumed that the refusal by my insurance was not a sign that it the DS was no longer prescription but that the script had been submitted incorrectly.
Age 53. Diagnosed UP 1983, Azulphidine
Diagnosed UC 1986 Prednisone almost 2 years
Asacol - 16 pills/day, cortenemas, Rowasa
Metamucil - 2 doses/day since '86
VSL#3, Ultimate Flora Critical Care
Vitamins, Calcium and D, Flax Seed Oil
Bee propolis, melatonin, slippery elm
homemade yogurt each day
Ryzolt for arthritis pain


gigifox
New Member


Date Joined Feb 2011
Total Posts : 1
   Posted 2/10/2011 1:28 AM (GMT -6)   
My insurance just changed from Blue Cross to Blue Shield in Jan 2011 --I was getting Rx VSL #3DS from Blue Cross , (although copay was $50)all last year 2 packets a day and it (along with Humira) was keeping me in remission for severe UC and C-Diff after 5 hospitalizations in the past year and a half!! Now Blue Shield says it is not on their list of Rx drugs and they will not cover any of it for a cost now of $300 for the same amount--I was having so much success with it that I am afraid to try anything else!! Any suggestions on how to get them to consider covering part like I had done in the past and also is there a good substitute?  (there are so many probiotics out there and some have given me gas in the past)  The new insurance company also gave me a hassle trying to get Humira because it is being used off-label for UC for me--it took over a month for them to approve it after many appeals--even though I have been in remission with it for almost a year (I had allergic reactions to Asacol, Lialda and Remicade--serum sickness hospitalization)  Just some info for anyone who has a problem like this with insurance--I requested a case manager (who is usually an RN with good medical background) to help deal with the nonmedical beauracrats and was approved for Humira in a day!!!!!!!!!!  ALWAYS, ALWAYS request a case manager who will be on your side--many people don't know they can do this!! I have been trying to get the case manager's help with VSL #3 DS, but with no luck so far because it is not even on "the list"!! Thanks for any help or suggestions!! rolleyes

aguywithuc
Veteran Member


Date Joined Jun 2010
Total Posts : 2459
   Posted 2/10/2011 8:51 AM (GMT -6)   
There is no way merely changing the quantity will work for me. They are not covering it because it is a 'medical food' and they categorically do not pay for *any* 'supplements'. Someone here posted how to have your Doctor write the appeal letter. I showed that to my Doctor and he sprang into action. Basically you threaten them with more expensive Remicade/Imuran and point out that VSL3DS has worked for you. The poster said it was approved within 48 hours. This has not happened for me but at least we made the right appeal - still waiting. Meanwhile back at the ranch I will go about creating my own yogurt from VSL3DS and growing my own if you will.

indie1962
New Member


Date Joined Jun 2012
Total Posts : 2
   Posted 6/25/2012 10:07 PM (GMT -6)   
Does anyone have a copy of that letter?  I don't have UC, but Sarcoidosis, and the VSL#3 was clearing up the lesions on my face, as well has curing the IBS-related asthma, before the insurance co. cut me off.  I was taking 4 DS per day.  I suppose I could threaten with one of the anti-inflammatories they've been trying to get me to take too, Humira, Methotrexate, Plaquinil, etc.
 
thanks!!!!
 
 

Sibby
Veteran Member


Date Joined Apr 2010
Total Posts : 1237
   Posted 6/25/2012 11:00 PM (GMT -6)   
Can Canadians get coverage for VSL? I talked with my GP and he tried to find out about getting coverage but nothing came up on his system.
23 · F · Ont., Canada
Inactive left-sided UC · Last scope: 0% inflammation
Asthma, lactose intolerant, IBS, migraine headache
Salofalk - symptoms worse
Imuran, 50mg · Alesse 21 · Folic acid, 5mg · Inderal, 10mg · Multiple vitamins · LDN (soon)
Temp: Cipralex, Doxepin
Good: fruits, vegetables, white meat
Bad: dairy, red meat, alcohol, high: fat, fried, salt, sugar, wheat
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