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Old 05-02-2007, 12:17 PM   #1
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IZZY'SMOM HB User
HELP! Turned down by new insurance company b/c of meds!

Help guys,
We tried to get insurance this last week and this morning the rep called and said we were denied because of my Fentanyl patches 75 mg., and hydrocodone 15 mg. 4 per day.
Ive been on this for less than a year. my current insurance pays nothing for any p/t and other avenues for therapy. I had an auto accident about 8 yrs ago that resulted in my having a neck injury that has always come and gone, but has gotten worse over the last year. I had an MRI last summer and I dont have it in front of me, something about bulging disks. The auto insurance i had years ago initially paid for the huge issues, but its been so long ago that IIM not covered by them any more of course.
My current insurance is BCBS, and my deductable is 5000.00 yearly, and of course my MRI was last year, so here I am starting the year over again. I pay for my meds basically out of pocket becuase i havent met my deductable. Has anyone else had this happen? can we even discuss insurnace companies here? I cant appeal it for 6 months!
My hubby is so supportive but i feel so badly that my meds have made it impossible for us all to have the same plan. The insurance guy [who is new with this company] acted like i had the plague because Im taking such strong stuff...and told me its because of me. So needless to say, well look for someone who is compassionate and helpful, not someone who just wants a comission. We actually had the nerve to tell me I should go into my doc and ask to be taken off the patches and try something less strong. He didnt even know what the patches were when we were filling the forms out, the insurance company told him that they dont like to cover anyone on them, because they can cause cancer!!!! So we're searching for something else. I also have a 11 yr old son, who is on our family policy. Am I going to have to get another policy for myself? Will ANYone cover me? The only reason I have insurance now is because this flared up last year and i was already on this policy. I hope this makes sense...
ANY help would be greatly appreciated!!
xoxoxoxoxoox,
IZZY'SMOM

Last edited by IZZY'SMOM; 05-02-2007 at 01:49 PM.

 
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Old 05-02-2007, 12:40 PM   #2
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Re: HELP! Turned down by new insurance company b/c of meds!

I am sorry for your experience and dont have much to offer in terms of help but just morale support. I know that I am uninsurable because of my chronic pain and meds. My employer changed insurance companies once (back when I was still employed) and even though they were forced to keep me insured the new insurance company would not cover anything that was related to pain management because they claimed it was an exclusion in the policy. My doctor even tried creative diagnoses and such with absolutely no luck.

Appeal probably wont do any good. Most insurance companies insist on a given period of time of being free from symptoms and treatment. Before disability kicked in I was advised to just try to get major medical coverage in case of something not related to my injuries. Other than that there was no recourse. There is an "insurance issues" area on these boards. Try that.

Sorry. Maybe someone else has better news for you. Liz

 
Old 05-02-2007, 12:47 PM   #3
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Re: HELP! Turned down by new insurance company b/c of meds!

Thanks Liz,
Welcome to the boards! im in Colorado as well, and it seems so backward...how can i be free of symptoms when i need the physical therapy, ect that they dont pay anything on. what a drag~
Thanks again!
xoxoxoxoxoxo,
IZZY'SMOM

 
Old 05-02-2007, 01:02 PM   #4
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cape1963 HB User
Re: HELP! Turned down by new insurance company b/c of meds!

I was turned down by every insurance co when I tried to get a policy as an individual....also because of my back condition. We now have a group policy where I work. We have an open access, HMO policy with Aetna. I've been with Aetna before.....what a wonderfuld insur co!!! I just rec'd a pamphlet in the mail asking me if I want to sign up for a back condition class. It's free and will do nothing but give me great advice!!! I just love Aetna. They cover all my meds and all my visits...no waiting period either.....I went through a lot of insurance companies before coming across Aetna. Aetna knew all my meds and conditions and will still cover everything. A group policy has to accept you, no matter what is wrong.

 
Old 05-02-2007, 01:33 PM   #5
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Re: HELP! Turned down by new insurance company b/c of meds!

Thanks Cape!
Ill check it out~ But are the premiums really high? sometimesz they make up for that by charging high premiums. Are they reasonable =, I guess I should ask.
xoxoxoxox,
IZZY'SMOM

 
Old 05-02-2007, 02:05 PM   #6
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Re: HELP! Turned down by new insurance company b/c of meds!

We have the same hmo as cape izzy and it is great.I was so against HMO's when we first started since we had Blue cross but my husband was diag with lung cancer in 2005 and we were given the best choice of hospitals. We went to Moffitt for his surgery (10 days) and then 12 weeks of chemo at our local cancer center and out of pocket all we paid was $1500 and that was for the whole year. We were even getting checks back from other doctors since at the time we didn't know about paying out of pocket $1500.
This year we just got a letter from aetna saying our out of pocket reached $1450 and do not pay any co pays when we reached $1500.If we had Blue cross we would have paid so much more everything was different. You had too pay 20% here or 80 % there I can't imagine how much we would have had to pay. Look into it.

Last edited by lorriem; 05-02-2007 at 02:15 PM.

 
Old 05-02-2007, 02:14 PM   #7
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Re: HELP! Turned down by new insurance company b/c of meds!

THANK YOU ALL SO MUCH! I knew i could count on all for you for your help and advice. Hubby has been making some calls this morning and I told him to wait until I got some feedback form all of you because I knew it would pay off. Thank you so much for your help, I love this board to death~ keep on posting, I can use all the feedback I can get! I dont know if this makes any difference, but we live in teeny town with one hospital. And the nearest places like like Kaiser, ect is in Denver hours away. So Kaiser wouldnt be an option... i just talked to the doctors office and some lady told me that now if i appled to this company and got turned down im in the system and i wont get covered by anyone? yeesh....i told her that a group would HAVE to take me and she agreed. Am i getting wrong advice, or did she not know what she was talking about!~
xoxoxoxo,
IZZY'SMOM

Last edited by IZZY'SMOM; 05-02-2007 at 02:20 PM.

 
Old 05-02-2007, 02:47 PM   #8
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Re: HELP! Turned down by new insurance company b/c of meds!

I think she is right.I know that even before my husbands cancer no ins co would touch him because of his asthma.We tried to get the same Blue Cross that he had before he quit his job for this new one so there would be no gap but they said no so we had to get cobrs for a few months until his new ins kicked in.

 
Old 05-02-2007, 03:00 PM   #9
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mudbone HB User
Re: HELP! Turned down by new insurance company b/c of meds!

Hi Izzy, I really feel for you. The only advice I can offer is if you can find a dr that will precribe what you need. Tell him your situation and he may reduce your visit cost, then there are many resources on the web for greatly reduced cost if not free meds. I have not travled that road before so I cannot give you any firsthand advise, but maybe others can. I wish I had better advise, but this is the website to read posts that will give you great advise. I wish you the best! Mud

 
Old 05-02-2007, 03:25 PM   #10
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Wren9 HB User
Re: HELP! Turned down by new insurance company b/c of meds!

I too have Aetna...provided through my significant other's employer -- a major "big box" store.

The name of my insurance is "Managed Health" and it is wonderful. I guess it is an HMO, but really it seems more like a PPO.

I have to see a doctor that is on the plan...they have a comprehensive list of doctors in all specialities, which included the pain doctor that I now see.

If I want to see a specialist, I just go seem them -- no "pre-auth" is necessary.

They have not denied any of my meds, including Provigil, which I've heard often gets denied. They also paid over $2000 for a 15-day prescription of Opana -- one month would have been close to $4000. They pay over $1000. a month for my Oxycontin. My prescription copay is between $5 min. and $50 max. Office co-pays are $15. The insurance covers chiropractic and massage with a $15 copay.

I have been where you are though, IZZY'SMOM. I was without insurance when I first got injured. I was in SEVERE pain (lower back pain and sciatica in both legs) for that time and I could not afford treatment. As a result of going untreated for so long, I have permanant nerve damage and numbness. After two years, I finally found a community health service that paid for my MRI and subsequently paid for back surgery. I'm not from this area originally, so I was not familiar with (the very limited) social services. The community health centers that I went when I was "indigent" would not provide pain management though, not even Vicodin.

I finally got health insurance coverage on my own -- Nationwide -- but I did not list my back condition. But I never used that insurance...because I finally got covered by my partner.

When I got covered by Nationwide, it was after applying to a different company that denied me...not ALL companies share info, but some do. Also, I have asthma, and I was honest about that on my application (and I still got accepted) ... on the application I wrote something like "mild asthma that is controlled by medication."

Group health plans through your or a spouse's employer...sometimes that is the only way to get coverage when you have a pre-existing condition. You can also look into free or reduced medical care, sometimes offered by the county or state. And then there's social security disability, medicare, but I don't know too much about that. There are also free or inexpensive prescription drug cards that offer some very dicounted rates on prescriptions...these cards can be found online. And some drug companies will provide medications free of charge or at a reduced rate.

-Wren

Last edited by Wren9; 05-02-2007 at 03:30 PM.

 
Old 05-02-2007, 03:43 PM   #11
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conductor HB User
Re: HELP! Turned down by new insurance company b/c of meds!

Dear IZZY'SMOM,

With the patches coming in generic nowadays, I don't see how these medications should be able to keep you from getting overall coverage. Plus, your breakthrough medicine is as cheap as they come!

Just because they said you have to wait 6 months for an appeal, do you have to wait 6 months to appeal because you got screwed by an agent who was strictly on the war-path for a commision??? It sounds like your agent made the decision--and who is he to give you medical advice?? He told you to tell your doctor to prescribe something else? I take the patch, 75 mcg, and I would just die without its help.

I still have coverage from an employer I left nearly 7 years ago. My coverage initially started when I worked. Then, I obtained 6 months of COBRA coverage. Then, the policy was transferred to regular coverage. Yes, I pay $300/month for the policy, but it pays so well for my medications that it is worth every penny. $10 per month for 15 patches. $10 per month for 60 Actiq. $10 per month for 100 Dilaudid. These are just a few of my medications, but they are items that save my life.

IZZY...Again, you offer us so much encouragement and help here on the board that I hope we can find someone who knows the answer that will help you quickly!

Let us know how this progresses...And it WILL progress because you are not a quitter!!

Sincerely,
Jon (Conductor)

 
Old 05-02-2007, 04:07 PM   #12
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Re: HELP! Turned down by new insurance company b/c of meds!

Hey Jon~
Thanks so much for the support~I would die without the patch as well...Ive taken on two other children ages 8 and 5 due to their mothers death, and have my own son 11 as well! It takes all i can do to function every day. IM so p***ED at the stupid agent who didnt even ask me questions or fill out my health questionaire IN PERSON, he went to my hubbys employment and said..."no worries we'll just fill these out in general." I was livid today when hubby came home and told him its MY condition MY body, id like to answer my own questions, thank you. Well the insurance guy smelled $$$$ and if you ask me was VERY inappropriate and non professional filling out the forms himself, or asking my hubby anything. He did call me and ask me what meds i was on, and i gave him the SANDOZ and the hydro 15 compound...not why or anything, just what meds, and didnt even know what the patches were, and then listens to his insurance company who says they wont cover anyone on them because they CAUSE cancer? i am still angry.
Im sIck of ppl who are clueless about chronic pain...my husband tried to get all of this done b/c i was out of the state at the time, but I told him tonite, that if he wouldnt have let this guy steamroll us to try to sign us and get his comission, we could have had a shot at other options. ive never heard of an agent taking info from someone other than the person themselves.
Anyway, now im stuck with the aftermath, and will have to try other options. and by the way, Jon...the insurance agent told me today that "some guy there made a judgement call about carrying me", then said hed call them again, THEN called back and said "they wont budge."
This is such a mess...so I am NOT appealing with this guy or his company, and we are looking somewhere else. He said, get this..."we have some time here...You could get off of the patches and your meds in 3 months and all." IM DEAD SERIOUS! Im sorry, but hes a moron...IM NOT giving up my quality of life so he can sign us, and i told him that... Guess Im just angry tonite and sorry to lash out, i think Ive made myself ill...
xoxoxoxox,
IZZY'SMOM

Last edited by IZZY'SMOM; 05-02-2007 at 04:47 PM.

 
Old 05-02-2007, 05:00 PM   #13
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Re: HELP! Turned down by new insurance company b/c of meds!

IZZY'SMOM, you mentioned a couple times how the agent said that the reason for denial was that the patches cause cancer? I'm wondering if there might be some misunderstanding -- which can hopefully then be resolved. These patches are often used FOR CANCER-related pain. In fact, I think that they were originally approved specifically for the treatment of cancer pain and some insurance companies will not cover them for nonmalignant chronic pain. Maybe the company thinks that you must have cancer since you are on the patch. Or they just really got it wrong and won't cover you because they think the patch causes cancer. Either way they are wrong. Explain the error and see what happens. Can you deal with a different agent? This one sounds like a lost cause.

-Wren

 
Old 05-02-2007, 07:25 PM   #14
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IZZY'SMOM HB User
Re: HELP! Turned down by new insurance company b/c of meds!

Hi Wren~
Thanks for youe reply...Actually i contacted the agent, and to be honest, he pushed my husband into all of this crap, and my husband is too nice to say no..We actually have had a few blowups about it tonite, and its not worth it.
Anyone who is a professional would have their facts straight, and not take any infor via a 3rd person. IM jsut glad to be rid of him, but if its true that now im in the system, due to him not having his facts straight, Im really angry.
He assured my husband that it was just fine to have him answer all of the questions...ugh~
i feel like reporting him...
Anyway we will look at other options, and make sure this doesnt happen again~
thanks for all of the advice, I was just wanting to see what worked for everyone else!
Thanks again!
xoxoxoxox,
IZZY'SMOM

 
Old 05-02-2007, 07:27 PM   #15
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conductor HB User
Re: HELP! Turned down by new insurance company b/c of meds!

Dear IZZY'SMOM,

Wren9 has a good point--maybe this company is so stupid that they think they would be covering you as a cancer patient!

Imagine...These patches actually causing cancer--give me a break.

And, IZZY'SMOM, that's what we're here for. You can lash out in my direction any time. Just as long as you're willing to listen to my lashing out!

You are probably right...this whole experience doesn't sound right. You didn't get a chance to answer the questions or explain anything. ARE THEY SERIOUS? Getting off of your patch--your medical salvation--in three months?? And you would probably go back to feeling horrible (or worse now that you know something works).

I know there's something right out there, and I'm again believing that someone reading this thread has the right suggestion for you!!

Take care,
Jon (Conductor)

 
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