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PostPosted: Thu Nov 18, 2010 11:16 pm 
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Hat - Thank you very much for that advice that makes a lot of sense.

I called my doctors office earlier in the week to let them know it was denied. They told me they would contact the insurance company and let me know.... I never heard back from them so I decided to call my doctor's office today. My doctor's office stated they re-sent authorization etc..and haven't heard anything.

So, I called the insurance company. The insurance company stated I'm approved for the next three months and they don't see anything coming in for a change of dose....They also stated they didn't receive anything from my doctor... Weird... Hmmmm, what you said really makes sense with the way this is going here... It does sound to me like they think I'm trying to refill my script to earlier.

I'll give the pharmacy a call first thing in the morning - thanks for the advice.

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 Post subject: Insurance Problems
PostPosted: Sat Nov 20, 2010 10:00 pm 
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Well, I ended up calling the pharmacy like you suggested Hat and they just told me the insurance is waiting for a prior authorization. I called the insurance company and told them this is a change of dose etc....they mentioned again they are waiting on prior authorization from the doctor... It's like a merry go round. I called my doctor's office again and the receptionist is getting frustrated at this point. She faxed the info over again (third time I believe). This is all going on Friday by the way.. So I waited a few hours and called the insurance company. They finally received the authorization and told me it should be clear by end of business day Friday. The insurance company also understands this is a raise in my dosage it was documented on the paperwork. Well, Friday night passed and nothing cleared.

I think part of the problem is I received a new script within two weeks of the first script. The new script is for a full month's worth of medication. Not the additional pills for the two weeks... I hope all of this makes sense. :lol: Well, it's aggravating as I used more of my current script to assist with my back pain. Now I have to pay cash for some additional pills to cover me until the refill.

I'll be calling my doctors office Monday to request a call back from the doctor himself. I want him to understand fully what's going on...

See ya,

SuperBuper


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PostPosted: Sat Nov 20, 2010 11:53 pm 
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I don't understand why your insurance company is giving you such a problem, except maybe just because they are an insurance company.

All they need to know is it was a dosage increase. He may have increased your dose the second day of your last refill by phone and you were taking double the whole time and now it was time for an "early" refill. Does that make sense? (I'm not sure I explained that right.) That's how it's always worked for me. But I guess I'll count myself lucky that my insurance company doesn't give me shit all the time. I'm really sorry this is happening to you. Keep us posted.

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PostPosted: Mon Nov 22, 2010 10:52 pm 
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Hat - I totally understood what you meant....I really don't know what type of communication is being passed between doctors office/insurance company etc... I would only think it would be common sense...

Anyways, here's the deal so far... I called this AM.....they denied the doctors request for the increased dosage. I spoke to a really nice woman at the insurance company. She told me the doctor's office is not filling out the form properly.. They did not have the correct dosage per day for the amount of pills they prescribed me and they did not explain why I needed the increased dosage. I'm finding out the office manager I'm dealing with is a B!*CH. She actually told me she can't help me anymore with chasing the insurance company and this is the last time she's faxing the paperwork over.. I was pissed... She's not even calling the insurance company...she is faxing..(I do understand she's busy but I thought that was quite rude what she said to me) I'm the middle man spending all the time on the phone going back and forth....today I even asked the office manager if the doctor could call me.... I wanted to let him know what's going on as he is extremely understanding.. She ended up faxing the paperwork over as soon as we hung up the phone...I found this out because I followed up this afternoon. She read the entire document to me and it was NOW exactly what the insurance company has requested. I called the insurance company up and they haven't received the fax yet....The insurance company told me there are 70+ faxes in the queue as they are upgrading their system. :roll:


That's where I'm at....running out of medication.....but it's okay, I called my pharmacy and confirmed I could purchase a few of the pills if necessary until this is cleared up...


and oh...the doctor never called me... I'm betting she never said anything to him.....

SuperBuper


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PostPosted: Mon Nov 22, 2010 11:03 pm 
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Sheesh, Super, it's like you can't catch a break. I have to say, with all that jumping through hoops they've got you doing, you certainly seem to be taking it in stride. Good for you for not getting bent out of shape when you're doing all you can do anyway. I really hope it gets worked out soon! :)

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 Post subject: Thanks
PostPosted: Wed Nov 24, 2010 10:26 pm 
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Thanks Hat for the compliment.. Lately I have been doing really well... The house stuff is done, I'm starting to save and I'm clean today. Life is so good waking up and enjoying life without chasing a high. I'm annoyed about the entire situation but there's nothing I can do. I know I can simply go back to my normal dose. I also know if necessary I can taper back a bit, skip a dose and for me have no affect at all.

Here's the interesting part... The doctor called me and asked me what's going on. I told him I really wasn't happy that the manager (receptionist) has told me she can't help me anymore. He told me they have too many patients to continue pulling my chart - faxing the information etc... I keep thinking to myself well she can't call again and make sure the fax gets there... I guess I'm being self centered....

I literally have spent hours on the phone with the insurance company already with this issue. She has stated she has faxed the information over 3 or 4 times... Well finally today the insurance company received the fax. I really believe the issue is on the insurance company’s side... unfortunately for me the insurance company said they still haven't filled out the form properly.

I have given up with this as of today.. I'm going to see the doctor at the end of December and request to see the information they faxed over. I know exactly what I told the receptionist what was needed on the form per the insurance company. At this time, I will decide if I need to find another doctor or not.

So, I'm back on my normal dose getting low on my medication. It's really ashame because the additional Suboxone really helped take the edge off my lower back pain.

SuperBuper


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 Post subject: YAHOO!
PostPosted: Wed Dec 01, 2010 9:28 pm 
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Coventry has approved my new dosage!! They finally received the correct fax and approved the new dosage for three months. So I'm now doing 1/2 tablet four times a day to assist with my back pain and it's working wonders.

Seems like the trick is the "Letter of Medical Necessity".

I haven't had much time to read through these forums for similiar experiences. What happens after three months? Another letter and then another approval? Do they eventually just allow me to be on the medication without any further issues?

SuperBuper


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