ABX and Insurance denial

[Mayzoo]

Our insurance (new group in April, same company) has decided in their infinate ignorance that my child may not have more than 60 tabs of an abx in a 5 month period. The doc tried an override for encephalitis, but insurance still denies as med not approved for that dx.

 

She has been on this paticular abx for 2.5 years. I am sure they will deny her other abx when I call it in soon.

 

Anyone else having this issue?

[airial95]

We had a similar issue, my son has been on multiple abx consistently for 4+ years now. Last year, I went to the pharmacy to pick up a refill and our pharmacist told me the insurance company had given them issues, denying the refills that they had previously been approving. I don't know what our pharmacist did/said, but she told me she was on the phone with the insurance company and our doctor all day fighting the insurance. In the end, we got our abx and haven't had a problem since.

 

Wish I knew more of what she had said/done, but she left our local pharmacy to work over at the cancer hospital

[Mayzoo]

I was already planning a switch to herbal abx, but was hoping for a bit more gradual switch. I will work this out one way or the other, since I will not watch kiddo suffer.

 

Thanks

[nicklemama]

We had this issue when we were on an HMO. It's concerning to hear about.

[rowingmom]

We purchased all of our abx through CanadaDrugs.com. Not sure if this is available to you.

 

We couldn't afford to purchase them in the US, they were just too expensive and we were paying out of pocket because we are Canadian. Our local pharmacies wouldn't fill an rx written in NY.

 

Perhaps there is a good on-line pharmacy that might fill for you. I liked CanadaDrugs because all of their drugs were sourced in Canada, except tindamax which had to be imported from the UK.

[nicklemama]

I have used a Canadian pharmacy in the past for name brand minocycline. It's actually quite easy to do and much less than US pharmacies charge. I can't remember the name, offhand but I can try and find which pharmacy I used. Lots of people in the US with rheumatoid arthritis who are on the minocycline antibiotic protocol use Canadian pharmacies for name brand drugs.

Edited July 9, 2014 by nicklemama

[ktdommer]

Haven't had problem with insurance but actually had a pharmacy refuse to fill script as they were concerned about long term abx use. Didn't know it was their job and didn't know they were doctors.

Keep fighting. We do on other things. Put in appeals etc.

[Mayzoo]

We had this issue when we were on an HMO. It's concerning to hear about.

 

Scary part is we are not on an HMO. I steered clear of HMO for many reasons.

[Mayzoo]

We purchased all of our abx through CanadaDrugs.com. Not sure if this is available to you.

 

We couldn't afford to purchase them in the US, they were just too expensive and we were paying out of pocket because we are Canadian. Our local pharmacies wouldn't fill an rx written in NY.

 

Perhaps there is a good on-line pharmacy that might fill for you. I liked CanadaDrugs because all of their drugs were sourced in Canada, except tindamax which had to be imported from the UK.

 

I have other sources, so I will not watch her decline.

 

I fear this is the wave of the future for many. Insurance companies have been nixing therapies that were not deemed medically necessary now they are venturing into pharmaceutical and nixing anything that is not "an FDA approved indication" for that med.

[nicklemama]

Scary thought.