Insurance Company Denial

A board to discuss Low Dose Naltrexone (LDN) as a treatment for Multiple Sclerosis

Insurance Company Denial

Postby Mary » Fri Jan 06, 2006 3:34 pm

Atlantic Blue Cross has denied my claim for LDN. I submitted a special authorization form (after it was denied the first time) that the neurologist filled out, and they still won't allow me to put my prescription costs for LDN through for reimbursement. It reads "Established payment criteria indicates that Revia is not reimbursed for treatment of MS".

There are so many things wrong with this. First of all, shouldn't the medical "professionals" decide what will or won't treat MS (well, ultilmately the person afflicted should be able to decide what they want to do for a disease that there is no real treatment anyway), but these are the money people, the insurance guys -why don't they just do what is recommended for a medical condition when told by someone who took medicine at school, not accounting!

But the best part is the letter itself. It's addressed to the doctor, not to me. I'm copied on it! They're telling him that they won't reimburse me, didn't even bother to include me in the "Dear" part, I'm cc'd. My doctor really doesn't give a crap one way or another, its just his job, he'll get this letter and wonder who is this? Is this one of mine? (we're all cattle). And it's my claim, not his!

Just stupid. And discouraging. I didn't even want to challenge it because I didn't want to draw attention from anywhere at work that might out me. I just don't want to reveal anything, I'm not comfortable with it. But then I thought, well, I'll just do this one thing, get the doctor to fill in his "confirmation/recommendation" part, it won't be any big deal with a doctor's note.

In the end it won't come up at work and I'll continue to get it and be thankful it's as affordable as it is. The neurologist wants me on a CRAB drug. I wonder what happens when I put that through? Won't that be ridiculous if they approve a drug at $1500/month but not $50?

A rant.
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Mary
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Postby remnants » Fri Jan 06, 2006 7:13 pm

Well, you're one up on me. I can't even get a doctor to prescribe LDN. My neurologist won't even discuss the possibility of LDN. He is my third neurologist. I have also tried several GPs - no luck.

Interesting - the neurologist was willing to prescribe Neurontin for pain. When I got home, I researched that drug as I do all drugs. Apparently prescribing Neurontin for pain is an off-label prescription as is LDN.

You read all these articles telling you to educate yourself and take responsibility for your health care - afterall there certainly are plenty of errors in medicine - great advice - just try to find a doctor who is willing to accept you as a partner in your medical treatment. If you manage that, then you face obstacles at other levels.
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Oh boy....I've heard them all....

Postby JoyceF » Mon Jan 09, 2006 11:51 am

I hear these stories all that time and it just sickens me. I'll tell you that. I am so very glad that I am no longer that same person that believes that doctors and mainstream medicine is doing all in my best interest. It's really all about the money that everyone makes. I hate that one of the posters is having a hard time getting a prescription and if you let me know whereabouts you are, I have a bit of info about many doctors that are prescribing it. You can even write to me at wkendz32@hotmail.com if you are not comfortable discussing it here. The other poster here is having trouble getting it covered by insurance. That really is a crock cuz you are right...where would they be if we put in for all those expensive pharmaceuticals...aargggghhh. I am so very thankful that all I pay out of pocket for my LDN is $60.00 for 3 months and don't even submit to insurance. Not worth my aggravation but I hear you on being upset. It upsets me even think about all this but hey, at least you have found your way to the LDN. Almost 4 years for me and I'm very thankful.
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