Insurance

I am between a rock and a hard place with my insurance co. and my medications!

I have been taking a name brand medication for more than 2 years. At first we tried the generic form and found too many side effects and the medication proved ineffective for me. So my Dr. switched to the name brand version and I evened out and am doing fine. Stable. Great!

Well now my insurance co. says oh wait! you haven't tried the generic within the last 180 days so we will only give you the generic form. I have had my dr. write a letter, call them fax them everything I can think of and NO! they will not fill the script with the name brand. So now I have to go back to the generic which isn't good for me for 180 days! At the end of the "trial" period they (ins co.) will re-evaluate my history and see if it is working or not. Good grief, I am going to try to not be emotional, but the side effects are awful. Depression is one, upset tummy, heat/cold intolerance, headaches, dizzy, heart arrythmias (sp?), and the list goes on. I am frustrated, angry and I think it is wrong!
Letters, calls and pleas have fallen on deaf ears. It is all about money and profits! They don't care about the patients. "They", meaning the insurance Co.

So if I come across in my future post as being a little *itchy! you will know why.

Darn it! This sort of thing sure makes me upset!
Pacergirl

I have posted 3 messages today and the spam filter is all the same! interesting!!

7 Comments

I just found this for my city

by tcrabtree85 - 2009-12-03 01:12:30

I don't know if your city has this or not but you should look into it.

www.caremark.com


Pretty much it helps you if your insurance won't cover your prescription it's free to sign up and almost all pharmacy take it. It says it's free to sign up. I hope it will help you out. I am looking into it right now myself. I wish you luck.

Tammy

The Screaming Wheel ~ ~

by Carolyn65 - 2009-12-03 10:12:02

Thankfully, generic drugs have been ok w/me. I do know my heart Dr./his staff, stressed & always said to make sure I use/get the same manufacturer on my Warfarin (generic for Coumadin) upon each renewal or the prescription generic might change enough to throw my INR tech/me in a 'tiz!

My daughter-in-law has experienced seizures once in a great awhile over the years. She has always taken a brand name med. & her insurance co. has always "come thru". When her pharmacy gave her the generic kind last year, thankfully she noticed right off. After a hassle w/the pharmacy & having to call her Dr. to talk to the pharmacist, she was able to get her brand name ~ all because of a new insurance co. & their "flippant clerks"! Also, it did/does not hurt that my daughter-in-law can be quite outspoken, becoming a "really loud squeakin' wheel" & something mentioned about "law suits" after driving, having a seizure & causing casualties, ALL because of the insurance co. cutting costs! She has no problem now.
It is cold in TEXAS this weekend ~ Carolyn G. ( :

YEP ~ spam filter code is all the same each time.

Brand Names vs Generic Meds

by J.B. - 2009-12-03 11:12:15

I'm not suggesting this is an answer to your problem, but I have had a similar experience with name brand and generic medicines and I learned that all generics are not created equal. If you can get the name of the manfacturer of the generic that isn't good for you, you might see if you can get another brand to see if it is better.

dates

by Tracey_E - 2009-12-03 11:12:18

Do you have to take it for 180 days or just try it? Can you fill a prescrip once then switch to the good stuff? And I'd throw away that one, let the ins co think you're taking it and pay for the name brand out of pocket! Or just pay for it and be done with it. It's not right and it's not fair, but it beats being a mess with side effects.

Generic Meds

by mrag - 2009-12-03 11:12:22

I too also think you have a tough fight ahead. I would start a daily diary of how you feel though and I would send them a clear letter that you will hold them responsible for any ill effects especially since your doctor has supported you-you may even want to consult a medical malpractice lawyer (who are in my opinion worse than insurance companies, but...). Another action that might help is call the Insurance Commissioner's Office of your state. Usually it's a political appointment and you may get lucky and find one not already being bribed by the insurance industry.

The other thing I would do is a Google search on your drug and find out anything you can. Perhaps there is some documentation or research that supports your concerns.

Totally agree

by ppt - 2009-12-03 12:12:06

with the comments made by Patch and Tracey. Find some way to get the real deal - am afraid this whole situation is going to get worse with the "Health Reform" ! What I dont understand is why the Insurance industry has the right to override a Dr's prescription !!!

Insurance woes

by annaelliott76 - 2009-12-04 02:12:46

Mrag, you know what you're doing :)

This is just my 2 cents, take it for what it's worth.

If it were me, I would request a copy of my complete policy, including your prescription plan and any amendments that have been imposed to my coverage since inception. Find out exactly what the policy says it covers. Read it several times. A policy gives in one place and takes away in another place. Then I would request confirmation of their claim denial in writing with their reasons for denial and that all future communication be in writing. No phone calls. If it's not in writing, it never happened. Keep record of every communication. If there are phone calls, keep logs of times, dates, who I spoke with and what was discussed.

I think you get the idea...

From there, I would follow advice above. It's better to fight smarter than harder. Carolyn is right, the squeaky wheel gets the grease.

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