pedalinbob
Flashlight Enthusiast
the poetic justice is wonderful! this is kinda long, but the ending is worth it.
i was on a medication (Provigil), which was covered by my insurer. this med worked best for my condition.
my employer, without the consent of the RN's in my union, changed insurer.
the new insurer denied coverage for my med. they stated that i did not fall under the listed uses for the med.
the cost of this med is $200/month!
i was furious.
i gave the union and the insurer hell.
the insurer agreed to cover a less expensive alternate med that was $76/month (Metadate CD). this alternate med had been tried in the past, and always gave me a headache (not controlled by analgesia) and moderate loss of appetite.
i took this alternate med intermittently over the last year, and simply dealt with the side effects as best as i could.
well...i tried to refill my Metadate Rx last week--and was suddenly DENIED coverage!!!
i purchased the med out-of-pocket, and had my doc re-submit for prior authorization. it was believed that the insurer would capitulate, and i would be reimbursed my cost.
today, i received a denial stating "client criteria only covers medication for diagnosis of ADD, ADHD or narcolepsy".
i do not fall under this criteria.
until this time, i was resigned to accepting the use of Metadate...and now niether Metadate nor Provigil are covered.
desperate, i decided to contact the FDA.
well, well, well! the FDA has, as of early February, broadened the listed use for the original, and more expensive med, Provigil...i should now fall under the umbrella of listed uses!
Metadate: $76/month
Provigil: $200/month
the look on the (a-hole) insurers faces when they realilze that they burned themselves in an attempt to burn me...
PRICELESS!!!!!!!!!!
Bob
i was on a medication (Provigil), which was covered by my insurer. this med worked best for my condition.
my employer, without the consent of the RN's in my union, changed insurer.
the new insurer denied coverage for my med. they stated that i did not fall under the listed uses for the med.
the cost of this med is $200/month!
i was furious.
i gave the union and the insurer hell.
the insurer agreed to cover a less expensive alternate med that was $76/month (Metadate CD). this alternate med had been tried in the past, and always gave me a headache (not controlled by analgesia) and moderate loss of appetite.
i took this alternate med intermittently over the last year, and simply dealt with the side effects as best as i could.
well...i tried to refill my Metadate Rx last week--and was suddenly DENIED coverage!!!
i purchased the med out-of-pocket, and had my doc re-submit for prior authorization. it was believed that the insurer would capitulate, and i would be reimbursed my cost.
today, i received a denial stating "client criteria only covers medication for diagnosis of ADD, ADHD or narcolepsy".
i do not fall under this criteria.
until this time, i was resigned to accepting the use of Metadate...and now niether Metadate nor Provigil are covered.
desperate, i decided to contact the FDA.
well, well, well! the FDA has, as of early February, broadened the listed use for the original, and more expensive med, Provigil...i should now fall under the umbrella of listed uses!
Metadate: $76/month
Provigil: $200/month
the look on the (a-hole) insurers faces when they realilze that they burned themselves in an attempt to burn me...
PRICELESS!!!!!!!!!!
Bob