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Thread: How to get medication covered after paying out of pocket

  1. #1

    How to get medication covered after paying out of pocket

    Not sure where to post so I will start here. I will keep it short for now. I have been on my medication and insurance denies ever year as they do with most meds. After appeals and doctors intervention with notes and reasons why it should be prescribed they have sent a letter thanking the doctor for bringing it to their attention and medication will be approved for 1 year. After several years this is the worst it has been. I forget the exact percentage though it is quite high as to what percentage is written off script and depending on the cost either approved or if expensive denied??? Its been several months and several appeals to a outside judge who I knew was only going to follow the law and let it go to the next appeal above her. Her decision is based on the insurance company, the medication is written is outside FDA guidelines and not approved for spinal cord injury?

    Having the insurance company paying for my medication for several years do I have anywhere to turn? I followed the insurance companies idea of paying out of pocket until the prior auth was done so I paid not ever thinking it would be this long. If I could go without I would though then I would just lye in bed doing nothing. There must be somewhere to turn that would oversee NY state insurance.

    Any help or suggestions would be appreciated.

    Thanks

    Mark

  2. #2
    Senior Member Domosoyo's Avatar
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    Hi Mark- I would contact your state reps that work for you at the capitol there in Albany by phone or email. If they don't know the answer they have staff that can dig for you etc.

  3. #3
    Try this NY State Insurance Commissioner's Office:
    https://www.dfs.ny.gov/insurance/dfs_insurance.htm

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    I go through this every time my insurance changes but usually gets approved quickly. But if your paying out of pocket atleast try the app GoodRx might get it cheaper with them than actual insurance or atleast cheaper than what pharmacies will charge

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