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Insurance Work Arounds
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If you can't get your insurance to pay for the supplies you need, like a certain brand of insulin or device, here are the steps to take:
- Tell your doctor the problem and ask what the options are
- Get the new script and fill it. It will be rejected
- Now, request a prior authorization from your Dr. They send it to the insurance company, so be sure you know the fax number the insurance company wants them to use. 3.1 You sometimes have to get on the doctor and the insurance case a few times 3.2 Some insurance companies include an extra step or use other verbiage, but in my experience, this is the process for both private insurance and medicaid. Always call the insurance company to find out the next step.
- Now, sucescully fill the new script and observe the effects
- Report back to the doctor and repeat steps 1-4 until you find what works
- When the insurance rejects the script (now or in the future), your doctor writes and reuses a special "prior authorization" letter with all of the evidence that the patient medically requires a specific medication, based on the other products you've trialed that failed
- Now, your script SHOULD be covered 100% with a $0 co-pay (you will still have your usual principal and deductible on your insurance plan)
*we have only had to do this "trial" of the stuff the insurance wants to pay for once. Even changing insurance, the Dr was able to submit the evidence we had collected that we tried them and they didn't work.
If this has not been your experience, please fill in the gaps for others who are not helped by my own experience. I just wish people knew. Thanks!
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