Insurance - what they will and won't cover related to GERD?

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doghouse
Regular Member


Date Joined Oct 2007
Total Posts : 138
   Posted 1/27/2008 4:30 PM (GMT -6)   
Hi all....

Questions on how your insurance deals with some GERD related medications and procedures...and do you want to bang your head against the wall??

I took prevacid for years and went to get a refill and all the of the sudden I had to get "approval" from my insurance to get the prescription refilled.
Then I switched to Zegerid, they wanted approval too before they would fill the script. I'm still waiting, it's been over two weeks since the paperwork was submitted, for official insurance approval on the prescription. In the meantime I HAD to get it filled and pay $140 for 30 pills. Grrrr.. mad

Now I'm having a fundo on the 29th and I called my insurance to make sure I didn't need to be pre-approved or all that jazz and they said "nope". So now I'm wondering if after I have the surgery they're going to come back and say "oh, btw that's considered elective surgery and we won't cover it". The surgeon's office should have checked with my insurance too, right? I mean they want to get paid so I would think they want to make sure my insurance is going to cover it. I'm getting anxious about my surgery so now I'm getting paranoid that I've over looked something....I can't help it!! eyes They didn't list the fundo as "elective" in my insurance book.

Maybe I just need a Valium..... cool

Bo Peep
Regular Member


Date Joined Jan 2008
Total Posts : 227
   Posted 1/28/2008 4:33 AM (GMT -6)   
Hi doghouse. I was wondering about insurance covering the Nissen as it is elective. I rang my insurance company and everything is okay (I am in the UK though) and my surgeon said it is covered and there wouldn't be a problem. Phew! It would be terrible if they didn't! I would have to wait even longer so I could save up to have it! Now where did I put those Valium?

Elaine


HappilyWrapped
Regular Member


Date Joined Oct 2007
Total Posts : 183
   Posted 1/28/2008 9:16 AM (GMT -6)   
Doghouse,

The surgeon's office should have contacted your insurance company regarding your procedure by now - after all your surgery is tomorrow. Give a call to them and confirm that your insurance company OK'd the surgery. Better that you go into surgery feeling without the anxiety of insurance hanging over your head.

As to the prescription filling problem - 2 weeks a long time to wait. I'd keep hounding your doctor's staff and then contact the insurance company yourself to ensure your doctor sent the proper forms completed to their specification. Sometimes there can be a holdup if the wrong form is submitted or if one item on the form is left blank. That happened to me - the doctor submitted what he thought was the proper form, but it was an older version and the insurance company never bothered to contact the doctor's office to ask for a new form to be faxed. Once I got involved, things moved much quicker - like the next day I had my prescription.

I'll be thinking of you tomorrow..........good luck.

marthamae
Regular Member


Date Joined Jan 2008
Total Posts : 285
   Posted 1/28/2008 10:25 AM (GMT -6)   
I take Prilosec and got a weird letter the other day. My insurance told me that when I went to the pharmancy I needed to make sure I bought the BRAND name Prilosec and not the generic. Apparently my insurance has some deal going with the Prilosec company and they can buy the real stuff cheaper than the generic brand. Go figure!

doghouse
Regular Member


Date Joined Oct 2007
Total Posts : 138
   Posted 1/29/2008 12:15 AM (GMT -6)   
The doc's office and hospital has confirmed with my insurance company that all is well. I guess I had pre surgery jitters and had to panic about something. Thanks for all of the support!
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