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  #1  
Old 05-02-2012, 01:15 PM
FlikTheBlue FlikTheBlue is offline
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I pit insurance companies hassling over albuterol neb prescriptions

I have been having a lot of trouble getting insurance companies to cover prescriptions for albuterol nebulizer treatments. It seems they all need prior authorization now. These are on patients with longstanding copd and asthma. These are not new meds. What's going on with insurance all of a sudden harassing people and not wanting to pay for such an important medication?
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  #2  
Old 05-02-2012, 01:19 PM
furt furt is offline
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Originally Posted by FlikTheBlue View Post
I have been having a lot of trouble getting insurance companies to cover prescriptions for albuterol nebulizer treatments. It seems they all need prior authorization now. These are on patients with longstanding copd and asthma. These are not new meds. What's going on with insurance all of a sudden harassing people and not wanting to pay for such an important medication?
Not paying for it at all, or just requiring a new script every time?

Frankly, I don't see any reason it shouldn't be OTC. It is in other countries.
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  #3  
Old 05-02-2012, 02:33 PM
FlikTheBlue FlikTheBlue is offline
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The insurance company usually ends up paying for it. But it takes a phone call to the insurance company, sitting on hold, and then answering lots of silly questions. Does the patient have asthma or COPD? Yes, of course they do, that's why they take albuterol. Yet each time it's a waste of several minutes answering obvious questions. What's worse is that the pharmacists usually tell the patient its just a simple call and that "the doctor needs to authorize it." No, we don't. The prescription I gave the patient is the doctor's authorization. It's really the insurance company that is authorizing it. Unfortunately a lot of pharmacists make it seem like the delay in getting the medication is the doctor's fault rather than the insurance company, where the blame rightfully belongs.
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  #4  
Old 05-03-2012, 06:28 AM
MsRobyn MsRobyn is offline
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I've been through this before.

Make sure your patients know the best place to get their meds filled in terms of what their insurance will pay for. It may be that your patients are having them filled at retail pharmacies when the insurance would prefer that it be filled at their mail-order pharmacy or through a preferred DME provider. A lot of insurance companies are making that push because of cost containment, and they're hassling their customers, pharmacies, and doctors to force that change. Your office manager can make a call to the insurance company find out how they want the drug prescribed, and have your patients call so they understand this, as well.

FWIW, lots of insurance companies are getting weird about stuff like this. I've been through this with my own insurance; I was getting my meds once a month from a local retail pharmacy, when my insurance preferred that I get a 90-day supply from their mail-order service. I had to make a few phone calls to get stuff straightened out so I could continue to get my stuff once a month without a hassle.

I agree that it's stupid and pointless, but what do you expect from insurance companies these days?
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  #5  
Old 05-03-2012, 07:08 AM
BigAppleBucky BigAppleBucky is offline
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How about refusing a series of rabies vaccine?

Health Insurance company said the shots were "elective". In the history of the world there is only one known case of a survivor of rabies.

Ultimately, a top officer in the NY Department of Insurance called the president of the company and lectured him.

This happened to my wife about ten years ago. She had a possible exposure to rabies and wanted the shots. (It's only 7 nowadays and none to the diaphram)

She was being cautious as the chances of actually having contracted the desease were small - but the downside was huge.
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Old 05-03-2012, 02:40 PM
Lynn Bodoni Lynn Bodoni is offline
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Refusing to pay for RABIES treatment?

I hope that the shit rolled downhill until it reached the person who made this decision.
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  #7  
Old 05-03-2012, 04:10 PM
BigAppleBucky BigAppleBucky is offline
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Originally Posted by Lynn Bodoni View Post
Refusing to pay for RABIES treatment?

I hope that the shit rolled downhill until it reached the person who made this decision.
Forgot to say it was Aetna. After she got the first two shots at the department of health, my wife was finally covered and got the remaining shots covered by Aetna.

The district manager for Aetna called to apologize. I'm sure some lackey routinely said no to all but the most routine of coverages. No doubt, their SOP. You'd think they'd prefer covering the shots as a preventative rather than covering someone in the ICU for however long it took to die.

Paying bonuses for denials of coverage? How sick is that?
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  #8  
Old 05-04-2012, 10:25 AM
Long Time First Time Long Time First Time is offline
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Originally Posted by Lynn Bodoni View Post
Refusing to pay for RABIES treatment?

I hope that the shit rolled downhill until it reached the person who made this decision.
When I was in intern, I was one of 5 people exposed to a rabid bull. (Laboratory confirmation of rabies, not just a suspect). We all went to the student health service at the university where I worked, and was told by the doctor on call - "there is no instance of someone catching rabies from a herbivore, so they weren't going to pay for post-exposure vaccination." I got it because as an employee I was covered. The 4 exposed students had to pay out of pocket. I'm still amazed by this.
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