My insurance company wanted re-authorization from my neurologist for the continued use and subsequent coverage of my one medication. This action was triggered because I entered an older age group. I entered that group about ten years ago.
The best I can figure is this. I was changing my prescription from one pharmacy to an another. Their computer received and entered new and different data. This change may have reviewed my data and updated my age group status. Foiled by safeguards.
I was told that my age group needs to be cautious if using this medication which requires authorization from the prescribing doctor (along with a history of two prior unsuccessful prescriptions or non-prescriptions over a 30 -day, at least, trial period). It kind of seems that they're stacking, regardless of the cause, all head aches in one pile. Mine was a result of breaking my neck in two places.
My insurance company never sent me a prior letter that my medication needs to be re-authorized for continued insurance coverage. They denied the payment request at the point of purchase.
Surprise! Surprise! I was denied purchasing the medication that I've been taking over the years. Six prior different prescribed medications and two non-prescribed medications didn't come close to helping. I was cut off from re-filling my pills just when I needed them. No thirty day warning letter no instruction's. Cut off just when I needed them.
It was May 2003 when I broke my neck in two places. Dodged a bullet. Still a mess. Monty Python's sketch "Wink, Wink, Nudge, Nudge": "It's Deb's fault." "She caused it ." Girl's tend to high-five me.
Over two weeks pasted and still no medication. It cost, out of pocket, ninety some dollars.
Marijuana also never fails. All it takes is a hit or two to take all the secondary pain away. It's nice to relax and not be overly concerned with the position of my neck. Free market price dictates the price. Much of what I received dating back to 2004 was free. The source was never revealed.
Edit: The medication appeal was successful thanks to my doctor's report. The capsules were authorized for insurance payment. This didn't stop the pharmacy from still getting an unauthorized medication code.
The insurance representative (she was lovely and helpful) assured me that the technician updated, thus correcting, the authorization code for the capsules. An alarm sounded being a member of the Fishtown Intellectual Ghetto (FIG). My prescription is for tablets and not for capsules. The technician remained aloof after he was able to review my medication history. He re-checked after I told him my prescription would in essences become invalid due to the capsule designation. He then thankfully changed the designation from capsule to tablet. Authorization approved.
If they can straighten out this subtle mess, they should have no trouble straightening out the not so subtle mess of not notifying their customers thirty days before their medication will no-longer be authorized.
words by Roman Blazic