medication claim denied

[falbie13]

Hey everyone,
I got a phone call from my transplant coordinator today saying that my insurance will not pay for my cellcept. She asked them why they would pay for it initially after my transplant but not now and they responded that as of 2010 they will not pay for it. My coordinator even explained to them that without the medication, the transplant was pointless and how could they authorize and pay for a transplant and not the meds that are required for afterwards.
I was just wondering if anyone else has had problems like this with their insurance. I looked up the price of cellcept online and it is almost $900 dollars a month without insurance...which I cant afford.
Thanks for any input.

 

[falbie13]

Hey everyone,
I got a phone call from my transplant coordinator today saying that my insurance will not pay for my cellcept. She asked them why they would pay for it initially after my transplant but not now and they responded that as of 2010 they will not pay for it. My coordinator even explained to them that without the medication, the transplant was pointless and how could they authorize and pay for a transplant and not the meds that are required for afterwards.
I was just wondering if anyone else has had problems like this with their insurance. I looked up the price of cellcept online and it is almost $900 dollars a month without insurance...which I cant afford.
Thanks for any input.

 

[falbie13]

Hey everyone,
I got a phone call from my transplant coordinator today saying that my insurance will not pay for my cellcept. She asked them why they would pay for it initially after my transplant but not now and they responded that as of 2010 they will not pay for it. My coordinator even explained to them that without the medication, the transplant was pointless and how could they authorize and pay for a transplant and not the meds that are required for afterwards.
I was just wondering if anyone else has had problems like this with their insurance. I looked up the price of cellcept online and it is almost $900 dollars a month without insurance...which I cant afford.
Thanks for any input.

 

[falbie13]

Hey everyone,
I got a phone call from my transplant coordinator today saying that my insurance will not pay for my cellcept. She asked them why they would pay for it initially after my transplant but not now and they responded that as of 2010 they will not pay for it. My coordinator even explained to them that without the medication, the transplant was pointless and how could they authorize and pay for a transplant and not the meds that are required for afterwards.
I was just wondering if anyone else has had problems like this with their insurance. I looked up the price of cellcept online and it is almost $900 dollars a month without insurance...which I cant afford.
Thanks for any input.

 

[falbie13]

Hey everyone,
<br />I got a phone call from my transplant coordinator today saying that my insurance will not pay for my cellcept. She asked them why they would pay for it initially after my transplant but not now and they responded that as of 2010 they will not pay for it. My coordinator even explained to them that without the medication, the transplant was pointless and how could they authorize and pay for a transplant and not the meds that are required for afterwards.
<br />I was just wondering if anyone else has had problems like this with their insurance. I looked up the price of cellcept online and it is almost $900 dollars a month without insurance...which I cant afford.
<br />Thanks for any input.

 

[Ratatosk]

Did they indicate why it was denied? Is it a matter of it being a non-formulary? You need to find out why it was denied and file an appeal. If it's a question of it being considered a non-formulary, you may have to have your clinic file an exception to indicate to insurance why it's necessary.

 

[Ratatosk]

Did they indicate why it was denied? Is it a matter of it being a non-formulary? You need to find out why it was denied and file an appeal. If it's a question of it being considered a non-formulary, you may have to have your clinic file an exception to indicate to insurance why it's necessary.

 

[Ratatosk]

Did they indicate why it was denied? Is it a matter of it being a non-formulary? You need to find out why it was denied and file an appeal. If it's a question of it being considered a non-formulary, you may have to have your clinic file an exception to indicate to insurance why it's necessary.

 

[Ratatosk]

Did they indicate why it was denied? Is it a matter of it being a non-formulary? You need to find out why it was denied and file an appeal. If it's a question of it being considered a non-formulary, you may have to have your clinic file an exception to indicate to insurance why it's necessary.

 

[Ratatosk]

Did they indicate why it was denied? Is it a matter of it being a non-formulary? You need to find out why it was denied and file an appeal. If it's a question of it being considered a non-formulary, you may have to have your clinic file an exception to indicate to insurance why it's necessary.

 

[AnnieT]

I agree with the above poster. You need a a denial letter from the insurance company stating why. You can bring this to your healthcare provider and maybe they can do a letter of medical necessity?

 

[AnnieT]

I agree with the above poster. You need a a denial letter from the insurance company stating why. You can bring this to your healthcare provider and maybe they can do a letter of medical necessity?

 

[AnnieT]

I agree with the above poster. You need a a denial letter from the insurance company stating why. You can bring this to your healthcare provider and maybe they can do a letter of medical necessity?

 

[AnnieT]

I agree with the above poster. You need a a denial letter from the insurance company stating why. You can bring this to your healthcare provider and maybe they can do a letter of medical necessity?

 

[AnnieT]

I agree with the above poster. You need a a denial letter from the insurance company stating why. You can bring this to your healthcare provider and maybe they can do a letter of medical necessity?

 

[CFkitty]

That is outrageous!!!!!!

Can you contact the manufacturer or distributor? Do you go to a CF clinic? Their social worker might be able to steer you to resources for the interim, while you file an appeal (and definitely appeal that!). Also check different pharmacies/programs for things like 3-month supplies - that can save copays.

Good luck!

 

[CFkitty]

That is outrageous!!!!!!

Can you contact the manufacturer or distributor? Do you go to a CF clinic? Their social worker might be able to steer you to resources for the interim, while you file an appeal (and definitely appeal that!). Also check different pharmacies/programs for things like 3-month supplies - that can save copays.

Good luck!

 

[CFkitty]

That is outrageous!!!!!!

Can you contact the manufacturer or distributor? Do you go to a CF clinic? Their social worker might be able to steer you to resources for the interim, while you file an appeal (and definitely appeal that!). Also check different pharmacies/programs for things like 3-month supplies - that can save copays.

Good luck!

 

[CFkitty]

That is outrageous!!!!!!

Can you contact the manufacturer or distributor? Do you go to a CF clinic? Their social worker might be able to steer you to resources for the interim, while you file an appeal (and definitely appeal that!). Also check different pharmacies/programs for things like 3-month supplies - that can save copays.

Good luck!

 

[CFkitty]

That is outrageous!!!!!!
<br />
<br />Can you contact the manufacturer or distributor? Do you go to a CF clinic? Their social worker might be able to steer you to resources for the interim, while you file an appeal (and definitely appeal that!). Also check different pharmacies/programs for things like 3-month supplies - that can save copays.
<br />
<br />Good luck!