Queenneeee
08-04-2007, 12:17 AM
Hi all!! Well now along with my increased dosage of vicodin (10/650)4x daily I am now trying lyrica 75 two times a day. I haven't had any of the bad side effects just an occasional word mess up which my kidsLOVE to point out.... !! The Lyrica does seem to be taking the horrible pain away that usually occurs when I am due to take the next dose of vicodin,HOORAY . I am soooooo excited that after all this time something is giving me some relief. Now the bad part..... my insurance refuses to pay for any of it for me because it is not approved for my illness. My doctor was very helpful and gave me a very large supply of trial pills and said he will as long as he can. My question is ...... is there any way I can prove to my insurance that it is theraputic for me. They sent me a long letter saying why they won't pay but should I write back or anything telling them how the lyrica is helping me ?? Anyone have an suggestions on getting an insurance company to change their minds ?? I know I've posted alot this month but I've had so many questions and with my hearing coming up for SS this month this board is my god- send !! Take -care all :angel:
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Queenneeee
08-06-2007, 01:04 AM
anyone have advice about the insurance company covering my lyrica...... This board seems to have the best advice.... thanks in advance.....
DesertBloom
08-07-2007, 12:19 AM
Hi: Have you tried looking at your insurance co's appeal process? I got a med covered that wasn't covered by going through this process. I would imagine that each co does this a little differently, but look through you policy for appeals, or drug exceptions, and call the co and ask how you go about doing this.
In my case I had to have my dr fill out a form that stated my med was medically necessary and that there weren't any drug alternatives for it. If for some reason lyrica isn't considered med necessary, you can still try to get an appeal or drug exception.
After you get this info follow through with it, and DON'T give up on the first turn down, if there is one. You never know they may agree the first time around. Persistance is the key, and your drs help. Even if they turn you down once, you "have" a right to appeal the decision as well, so don't give up.
Try that and see what happens, and good luck. What type of insurance do you have, PPO, HMO, WC, Medicare etc?
In my case I had to have my dr fill out a form that stated my med was medically necessary and that there weren't any drug alternatives for it. If for some reason lyrica isn't considered med necessary, you can still try to get an appeal or drug exception.
After you get this info follow through with it, and DON'T give up on the first turn down, if there is one. You never know they may agree the first time around. Persistance is the key, and your drs help. Even if they turn you down once, you "have" a right to appeal the decision as well, so don't give up.
Try that and see what happens, and good luck. What type of insurance do you have, PPO, HMO, WC, Medicare etc?
Shoreline
08-07-2007, 12:38 AM
Hi Queene, Insurancwe will make exceptions when you have documented evidence that the meds they sugest or cover either don't work or are intolerable. I'm sure they expect most folks to just say OK and except this but they have allowed me to use out of network docs, attend out of network pain clinics. It's a hassle getting the aprior authorization but it may be possible. The doc can certainly apeal their decsion and write a letter of neccessity, I just wasn't sure if you had gone that route and this was their reponse to the docs letter?
There are also free med progrms but sadly some drugs are priced out of some peoples budget. Alot of people fall through the gap of not meeting criteria for help, but can't afford to spend half their income on a medication that some CEO made a 8 figure bonus on last year. :mad:
Good luck, Dave
There are also free med progrms but sadly some drugs are priced out of some peoples budget. Alot of people fall through the gap of not meeting criteria for help, but can't afford to spend half their income on a medication that some CEO made a 8 figure bonus on last year. :mad:
Good luck, Dave