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madddness | How can i get my health insurance to pay for a medication that they are refusing to pay for? |
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debijs
 |
~~It's hard to give a correct answer without knowing the denial reason, but it could be it needs proof of medical neccessity. There are some brand names which aren't covered, but if you failed on the gennerics, then the doctor needs to write a letter justifying the use of the particular med which is being rejected.
Some drugs, may be considered not medically necessary such as Retna-A, or sexual enhancement medications.
Find out the reason for denial and be more specific and repost. I'm sure you can get better information to help you.~~ |
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acermill
|
You can't, if the medication is not covered by your policy. The only things an insurer will pay for are those things specifically covered by the policy. |
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zippythejessi
|
It depends. You can not force an insurance to pay for something that is excluded from your policy - for example, if you have no mental health coverage and you're prescribed a psychotropic drug, you can't force them to pay for it. All you can do is provide evidence of medical necessity - the doctor will help you there - and ASK them in the form of an appeal - to reconsider their denial. If they uphold their denial, you've gotta either suck it up and pay out of pocket, or have the doctor find a suitable alternative.
*Also, if the medication is being used off-label (i.e. not for it's intended use) or experiemental - you're probably going to lose. |
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KG Mom
|
Depends on the med and diagnosis.
Can you give us more info? |
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MSAD
|
It depends on what the medication is for.
For example: many health insurance policies do not pay for birth control pills when used to prevent pregnancy. But BC is ofter prescribed to treat medical conditions (such as dysmenorrhea). I was on BC of medical reasons and the whole not getting pregnant thing was a nice perk. I had my dr write a note explaining that the BC was for dysmenorrhea and sent that into my health ins co and they covered the cost of the pills.
I know you don't need BC, but depending on what you are taking and why......if its a medical condition you may can get a note from your dr. |
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Ohno
|
Call your insurance company and ask if they have a generic of the same drug.
Also, talk to your doctor to see if he can prescribe a drug that is comparable so that your insurance will pay for it.
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Bub
|
I doubt you can. Just another reason for Universal Healthcare. Peace. |
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GARY B
 |
I have met this kind of problem before,here http://www.HealthInsuranceFreeTips.info/free-health-insurance.htm is the resource I found useful.
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