Over the past year, I've learned some stuff about dealing with insurance companies.
1. You can appeal. They hate appeals, but showing that you're persistent can help. If your doctor can clearly show that those meds are the ones you need, it may help get your prescriptions approved. Sometimes, you just need to clarify that they have all the information, like that you've been on a treatment for over a decade successfully. It could ridiculously be some missed annual paperwork. Really. Or they could be hoping you'll take suboptimal treatment and go away. Even if it's just submitting the proper paperwork/information, it's still an appeal/reassessment of the claim, etc. 2. If that doesn't work, you might be able to complain to your state board. Again, doctor testimony: If your current meds aren't working, and the other ones should.
Having recently done the appeal several times (missed paperwork, missed steps, outright corporate greed) and the complaint once (was closed when the insurance company reversed itself and covered nearly all my premature son's NICU bill rather than sticking us for $126k), as well as hearing of similar insurance battles from my mother's cancer survivor network, well, I can strongly recommend being the squeaky wheel.
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1. You can appeal. They hate appeals, but showing that you're persistent can help. If your doctor can clearly show that those meds are the ones you need, it may help get your prescriptions approved. Sometimes, you just need to clarify that they have all the information, like that you've been on a treatment for over a decade successfully. It could ridiculously be some missed annual paperwork. Really. Or they could be hoping you'll take suboptimal treatment and go away. Even if it's just submitting the proper paperwork/information, it's still an appeal/reassessment of the claim, etc.
2. If that doesn't work, you might be able to complain to your state board. Again, doctor testimony: If your current meds aren't working, and the other ones should.
Having recently done the appeal several times (missed paperwork, missed steps, outright corporate greed) and the complaint once (was closed when the insurance company reversed itself and covered nearly all my premature son's NICU bill rather than sticking us for $126k), as well as hearing of similar insurance battles from my mother's cancer survivor network, well, I can strongly recommend being the squeaky wheel.