Hello,
Is there a way for me to appeal directly (quickly) to my insurance company to cover a medication that they do not?
I was prescribed Emsam last Friday after tapering off Trintellix and going a full two weeks with no medications to avoid any interactions. The pharmacy did not have it on Friday and had to order it. It arrived today. The price is about $2000 for a 30 day supply. There is a manufacturer card that will bring it to about $1400.
I called BCBS of MA to see what my options were. They sent a prior auth form to the doctor, which I have no idea why that wasn’t done to begin with but fine. So the worst part of this is that my doctor is away for the next week on vacation, so they can’t fill out the prior auth form. Next Tuesday they return, then presumably it would potentially be approved next Wednesday at the earliest.
All the while I am on no medication and really struggling. I am not suicidal but just really really low. The weeks of tapering and waiting were excruciating enough but I knew they were necessary. But this added time is extremely frustrating and I am just barely controlling the anger.
I have been on at least 15 antidepressants in the last 5 years, SSRIs, SNRIs, tricyclic, atypical, antipsychotics… Nothing has provided more than a slight relief from constant tearfulness. Tried TMS as well. Been in therapy weekly for three years. Finally trying the MAOIs that the doctors seem so hesitant to prescribe. There is no reason they wouldn’t approve it as far as I can see. I have had several prior auths go through without issue in the last several years.
I am honestly more inclined to go pay the $1400 than wait another 10 days.
Thanks for any insight.
Edit for clarification: this is private PPO insurance
(originally posted this in /r/healthcare
submitted by /u/BottomSellingAuthor
[link] [comments]Hello, Is there a way for me to appeal directly (quickly) to my insurance company to cover a medication that they do not? I was prescribed Emsam last Friday after tapering off Trintellix and going a full two weeks with no medications to avoid any interactions. The pharmacy did not have it on Friday and had to order it. It arrived today. The price is about $2000 for a 30 day supply. There is a manufacturer card that will bring it to about $1400. I called BCBS of MA to see what my options were. They sent a prior auth form to the doctor, which I have no idea why that wasn’t done to begin with but fine. So the worst part of this is that my doctor is away for the next week on vacation, so they can’t fill out the prior auth form. Next Tuesday they return, then presumably it would potentially be approved next Wednesday at the earliest. All the while I am on no medication and really struggling. I am not suicidal but just really really low. The weeks of tapering and waiting were excruciating enough but I knew they were necessary. But this added time is extremely frustrating and I am just barely controlling the anger. I have been on at least 15 antidepressants in the last 5 years, SSRIs, SNRIs, tricyclic, atypical, antipsychotics… Nothing has provided more than a slight relief from constant tearfulness. Tried TMS as well. Been in therapy weekly for three years. Finally trying the MAOIs that the doctors seem so hesitant to prescribe. There is no reason they wouldn’t approve it as far as I can see. I have had several prior auths go through without issue in the last several years. I am honestly more inclined to go pay the $1400 than wait another 10 days. Thanks for any insight. Edit for clarification: this is private PPO insurance (originally posted this in /r/healthcare submitted by /u/BottomSellingAuthor [link] [comments]Read Morer/HealthInsurance