Insurance companies know more than your Doctor

Pinball Wizard
By Pinball Wizard Latest Reply 2011-07-15 16:56:49 -0500
Started 2011-07-15 10:52:15 -0500

I was on Januva since July, 2007 and my diabetes was in excellent control my A1C's were always 5.6 and under ,. January this year insurance said they're not covering Januva anymore and said I should take 1 of 3 they suggested,.2 of the 3 I can't take because if interaction with my Liver Transplant anti-rejection meds,. the one I could take OnGlyza my numbers sky rocketed where my A1C's are now 6.9 ,. my doctor is still trying to get me back on Januva,.I'm on Medicare Extra Help so I can't change insurance companies till December which I intend to do ,.
Why should insurance company be able to over rule what the Doctor presribed and works for you? ,.,. Of course I don't mind saying this has me stress ,.,.

8 replies

VaHermit 2011-07-15 16:46:56 -0500 Report

I was told that when you have diabetes and have a special needs plan you do not have to wait until December…I advise you to check on that. The rules changed before February this year or so I was told. Good Luck

JoleneAL 2011-07-15 15:15:30 -0500 Report

Same thing happens to me with my thyroid medications; doctor writes the script "as written" and Tricare keeps trying to get me something different, unproven on the market and it takes 8 - 10 weeks to determine if the drug is as effective. Fortunately, my pharmacy won't switch it like they want. Sorry you're having to go through this. As we age, we become more expensive and that is what happens unfortunately. And you're already on Medicare? God help me.

gbc43 2011-07-15 12:26:09 -0500 Report

BCBS cut its members off because of the price . Move it to a tier 3 and wanted $220.00 for 90 days …

lmkilday 2011-07-15 11:55:43 -0500 Report

Did your doctor explain the drug interaction problem to your insurance company? If not, have him/her send a letter to your insurance company and copy you on the letter. If the insurance company still refuses, contact an attorney about filing suit against the insurance company. An insurance company lost a suit brought by a patient whose condition worsened because the insurance company was making medical decisions. Most companies since then backed off trying to practice medicine. Check your policy first, they may require you to go through arbitration or an internal appeal process before you can file suit. An attorney will also request a copy of your policy. Good luck.

jayabee52 2011-07-15 11:36:44 -0500 Report

They should be working with your Dr. I have heard of situations like this, and Dr wrote to ins. co. and explained the problem to them, and often they would allow the med they denied previously.

Bunca Darned beancounters!

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