When a patient is first denied a claim or prescript
on refill, it is at the lowest level of the totem pole. A challenge is always merited when the diagnosis has been differential and affirmed by a trained specialist. Always appeal. This will actually protect the one who has not yet been denied once precedence is established.
First, your doctor needs to be involved and contact your prescription provider, either by phone or with a letter.
Second, you need to provide your insurance company with the following:
It is of the utmost to provide credible science and/or articles that have references to studies when challenging.
http://www.ilads.org/insurance.html - Insurance
http://www.ilads.org/cdc_paper.html - CDC
http://www.lymediseaseassociation.org/BurrGuide200509.pdf - guidelines
http://www.lymedisease.org/resources/insurance.html - appeal
http://www.beyondthecure.org/future/insurance/survivor/issues.html - contact your state's insurance commissioner.
http://www.patientadvocate.org/resources.php?p=178 - Insurance commissioners by state
The code of ethic if an unjust denial is determined by the insurance company is that the insurance carrier is considered to be acting in 'bad faith'. This is a legal term that would be applied in an appeal letter.
Taking these steps should bring about a resolution in your favor.
Hope this helps.
"God loves with a great love the man whose heart is bursting with a passion for the impossible." ~booth
www.stylebyheatherrose.com -click "Lyme testimony" and "Lyme Disease" for a panoramic view of the truth. Lyme disease - coming to a tick near you!