Healthcare question
08-18-2016 | 05:43 AM
#11
Gets Weekends Off
Joined: Jan 2008
Posts: 333
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From: 320A
One of my kids has a prescription that they take every day. Been on it for a couple of years. It has been covered by United and costs $20 a month. Went to get it filled last month and pharmacist says United is no longer covering this medicine. New cost - $850.00. So this prescription just went from $240 per year to over $10,000!
United basically says they believe that another medication is better. Thing is, our doctor had previously tried that medicine with very poor results, bad side effects, etc. We have written an appeal to UHC. They responded telling us to go pound sand. Basically, that they know what's better for my kid than her doctor and parents.
Anybody have any experience with this? Are there any avenues of relief I can explore with either the company or DALPA?
Thanks
United basically says they believe that another medication is better. Thing is, our doctor had previously tried that medicine with very poor results, bad side effects, etc. We have written an appeal to UHC. They responded telling us to go pound sand. Basically, that they know what's better for my kid than her doctor and parents.
Anybody have any experience with this? Are there any avenues of relief I can explore with either the company or DALPA?
Thanks
08-18-2016 | 05:59 AM
#12
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Joined: May 2010
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From: Captain, SS Orca
This appeal process is interesting, seems like there should be a third party. Basically, you're appealing to the company that told you to pound sand. You asked if you could stop pounding sand, they evaluated the situation and decided that it was in their best interest if you kept pounding sand. Not very fair.
Exactly.
Left message with Karen Brown Fleck at DALPA today. I will update with any results.
08-18-2016 | 06:01 AM
#13
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From: Captain, SS Orca
Yep, have fought this battle as well. Don't get me started on the:
"Well, it was coded as procedure #704. It should have been coded as #703. Since it was coded incorrectly, we will not cover"
Nevermind that we are talking about the same damn thing.
08-19-2016 | 02:11 AM
#14
Otto
Joined: Jul 2013
Posts: 1,806
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From: Turkish Pile Driver
So frustrating, I feel your pain brother. We had a somewhat similar problem and Karen was able to help us out, so there is hope.
Unfortunately it's not just UHC, it's the insurance industry in general. Cheaper to just deny 100% of all claims and then stall those who become the proverbial squeaky wheel than pay what they owe. Makes our management team look like Mother Theresa. Dealing with Blue Cross Blue Shield and Medicaid was another nightmare when my mother was injured in a car accident. The sheer maddening stupidity of these faceless organizations would be enough to drive anybody to the breaking point.
Unfortunately it's not just UHC, it's the insurance industry in general. Cheaper to just deny 100% of all claims and then stall those who become the proverbial squeaky wheel than pay what they owe. Makes our management team look like Mother Theresa. Dealing with Blue Cross Blue Shield and Medicaid was another nightmare when my mother was injured in a car accident. The sheer maddening stupidity of these faceless organizations would be enough to drive anybody to the breaking point.
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