posted
I still have a med problem. I took my new prescription to Costco and they said that the meds-biaxin and bicillin are not on my insurance's formulary list. They said that Blue Cross of CA needs prior authorization. I call my LLMD's office and they say maybe if they have the time they will call the pharmacy. Does anyone know what the MD needs to do. Everyone's unwillingness to help means I will have to really push for this. Is there a form the MD fills out or is it some kind of letter of medical need or just a phone call. Does different pharmacies get different results with the insurance. Is Costco part of the problem or does it not matter. I am worried because I now have no antibiotics and I am going on vacation for 2 weeks. Can a person relapse in 2 weeks? Thankyou!
Posts: 293 | From healdsburg, ca , sonoma | Registered: Feb 2005
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posted
your doctor needs to justify (i think either w/ a form or just a letter) why you need that specific medication.
this happened to me once when i breifly tried provigil. blue cross of ca doesn't cover it unless you're narcoleptic.
my doctor was a horrible lazy *** about the problem. luckily at the time i went to a great pharmacy and they hounded him to death.
different pharmacies won't get differnt results from the ins cos, but some pharmacists go above and beyond the call of duty and help you hound your doctor.
if you're going on vacation in 2 weeks, i'd hound your doctor, and maybe try to find a pharmacy with better customer service. (maybe a smaller business? though my favorite pharmacist ever worked at rite aid.)
when in doubt, hound the hell out of all responsible parties !
Posts: 12 | From california | Registered: Sep 2005
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posted
I have heard that your ins co denies just about everything, makes it such a hassle that patients and docs give up. It is intentional that they want your doc to justify this, tie the doc up in paperwork and discourage him/her from prescribing, or avoiding patients who have that ins.
Doc offices are drowning in paperwork caused by ins cos, especially the ones trying to weasel out of paying for anything.
BTW, your ins co is for profit, with everything that goes with it. The Blues used to all be non-profit, but that is changing.
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
When we are prescribed a med that needs prior authorization, the insurance company will fax the form to the doctor to fill out.
Fortunately, our LLMD is very good about that. Some of the meds have been denied and we either pay for it or try another med.
FYI - we have out-of-network coverage. Non-formulary meds are considered an out-of-network cost for our insurance. If I buy the meds, the insurance company will reimburse me 70% of the cost of the med.
Can you call your insurance company to ask for the procedure to follow for prior authorization meds?
Good Luck!
-------------------- Peggy
~ ~ Hope is a powerful medicine. ~ ~ Posts: 2775 | From MN | Registered: Apr 2001
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WildCondor
Unregistered
posted
Prior auntorization is a form your doctor needs to fill out and fax back to the insurance company, and the pharmacy can run it through again once you hear from the doctor and insurance that is has been approved. Its a pain, happens to me all the time with my meds. Bicillin, very common. Hang in there, hopefully you will get it soon. When you do, make sure they are storing the Bicillin in the fridge, make sure its Bicillin LA, not Bicillin CR, and that you have the right amount of it. :-) Good luck!
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