My LLMD started me on mepron and wanted to add Zithromax.
The insurance would only cover 3 pills. My LLMD put in an authorization for 12 pills per month, but apparently it was denied. Chapelle graciously called on my behalf and was told they would authorize 10! But when I called my pharmacy they said, No, only 3!
So I called the insurance and was told by a supervisor that 10 was approved and Target entered it wrong into the system. I called Target back and they tried again, and Nope!
Target called my insurance and spoke to processing, and was told only 3 pills are approved!
I called the insurance AGAIN and spoke to a different supervisor this time and was told, nope...only 3! And they couldn't explain why both Chapelle and I were told otherwise the first time.
Seems fishy. My 3 alternatives are:
1. Have LLMD submit another, more detailed, and convincing request
2. I could file an appeal
3. I could use biaxin instead. No problems.
I decided to try for the biaxin. If I have issues with it, it may give my LLMD more leverage to get the zith approved. I'm just furious as to how much time was wasted on this! Countless phone calls and hoops!
Does anyone else get this kind of run around?
Furthermore.....I was suppose to start the zith last week. Target won't have any biaxin til Monday. So I will be 2 weeks behind on my treatment. I will have been on Mepron for 3 whole weeks. I think Mepron needs another abx to work efficiently if I remember right. So, it's kind of a waste of mepron! And I KNOW Mepron is expensive.
I'm just curious if anyone else has gone through this? I can see where IV drugs may be an issue. But Zithromax??? I wonder if the Ins just wants to make it difficult for my LLMD to treat me. Maybe they are doing it because it's Lyme treatment and they want to screw the doctor? (My imagination is getting the better of me!)
Post Edited (Utahgal) : 2/27/2015 11:50:54 AM (GMT-7)