Pharmacy denied long-term abx

My husband and I both have had lyme disease also, though I just completed 7 months of abx and caught it fairly early and have been off abx for a month now. My husband has been ill for years. The problem is probably with your insurance company, not the pharmacy. When our scripts have been denied, the pharmacy calls our doctor and or insurance company and they have worked it out so far(knock on wood) to authorize them.
My husband's IV rocephin however was just denied after 28 days- and we're worried that they(insurance) may start denying other meds(including his mepron). We're not going through a mail order pharmacy though- but the problem is probably with the insurance co. Has the insurance company called your doctor?

Studeski,
That is awful! I am so sorry. That makes me mad a hell!
I mean you have a Dr. trying to treat a sick patient and the insurance company does not want to cover you. And they can deny
you because of certain doctors...yes I am saying their names. They can sue me. [Post edited: But HealingWell doesn't want to be sued!! No flaming or attacking members or non-members, as stated in the forum rules.]
Please, we need the media.
They tell the CDC how to set their test, awfully, it would not pick up lyme in your blood if you were covered in ticks.
And so there fore you are not sick. And so therefore you do not need any expenisve meds that are actually going to take money
out of the big boys pockets who have to see a profit with their sotcks in the insurance BUSSINESS.
hey...know anyone who lives on the boarder of mexico? think you can buy it over thre counter there.

Post Edited By Moderator (alfers) : 12/4/2008 8:10:49 PM (GMT-7)

When a patient is first denied a claim or prescripton 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/position2.html -

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.lymedisease.org/lyme_times/issues/lyme_times_issues_insurance.html

http://www.ct.gov/AG/cwp/view.asp?a=2795&q=414284

http://www.ct.gov/AG/cwp/view.asp?a=2795&q=414284

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.

Blessings,

Sojourner (Diana)

 

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