Help with prescription coverage nightmare

OK-- I got new coverage over the winter through my husband and when I went to fill my birth control, the insurance company told me I need prior authorization.

My OB/GYN's office says they have no time to call insurance companies to do prior authorizations.

Here I am, just a girl trying NOT to get pregnant, and Ive been paying out of pocket for my BC for four months because neither the insurance co. or the MD's office will bend their policy.

So I went for my annual today, hoping to get all of this settled, and the front desk at the MD would NOT budge, saying they have no time. I like my OB/GYN, but I left there practically in tears today because they wouldnt help me out.

Anyone have any advice....

Re: Help with prescription coverage nightmare

You need to call the insurance company and find out what they need from the doctor.

Then call, or better drop in, to the doctor's office and tell them they need to send the following over to the insurance company and that you will call back in 24 hours to find out if this was done. They usually have a set leter that they fax over.

If they say no, take your business elsewhere and report them to the insurance company.

Message edited 5/22/2006 6:31:07 PM.

Re: Help with prescription coverage nightmare

Change obs go to one who cares...My wrote a letter without a problem...Sham on them!

Re: Help with prescription coverage nightmare

Quite honestly if it were me and my doctors office told me 'they don't have time', I would be going to a different office - that is crap!

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Re: Help with prescription coverage nightmare

If the doctors office is telling you they don't have time, I would be very weary about other things that would be telling me or not telling me.

Is the thing that your new insurance company needs in your file? If so, tell your doctors office to give you a copy so that you can take care of it yourself.

And I am not sure why you would say - if you switch doctor you would not be covered.
Because you just had an exam? I would tell your office (that you are currently going to now) that you are switching doctors since they do not help you when you need it - and tell them you need the file for the new doctor.

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Re: Help with prescription coverage nightmare

Medical- GHI

Prescription- Caremark

Re: Help with prescription coverage nightmare

I wouldnt use a doctors office that ever told me this..
I also have to get authorization for most of my medication and they always called right away for me.
Im sorry..

In the meantime until you get them. take a multivitamine with extra folic acid.

Re: Help with prescription coverage nightmare

can you ask your PCP to do it? And then I would let your OB know you will be finding a new doctor.

Re: Help with prescription coverage nightmare

Thanks for all of your opinions. I was really pouring my heart out to the receptionist, explaining I needed help, and she wanted no part of it.

Im going to look into getting a new doctor.

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Amy,

That S*CKS. I guess switching doctors is best, call and make sure they will cover another visit this year though before you do anything.

So sorry you're going through this!

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I would have said "you have no time to call I have no time to pay my co-pay"

What dr office is this? That is really bad - I would call the insurance company and explain that this is the medication your doctor put you on and tell them what they told you maybe they can call your doctor instead of the doctor calling them - at least they are on notice that the doctor they use is non compliant with their policies.

I would also call your PCP and ask if they can call it in instead - and explain why - they might not do it - but you have nothing to lose to ask.

I always got stuck paying out of pocket for my BCP and so I understand - but my dr used to give me a few samples and since when you are on the pill you are supposed to go every 6months I only had to pay for maybe 6 packs over the year.

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That really s*cks...I would definatley look into another Doctor...Is it just that one type of BC?...Maybe there's another type of BC that they don't need authorization for...My insurance doesn't cover all types.

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Re: Help with prescription coverage nightmare

You need to report your doc's office to GHI and Caremark. It's in their contract to provide all services to their patients in accordance with GHI rules if they are a GHI doc.

Then I would dump their azz in a hurry. They are not in compliance with their GHI contract and I would not put my health in their hands if they are too busy.

My doc would never say no to me..I have never had a problem with any of my docs contacting the insurance company on my behalf. My doc takes almost any insurance and is extremely busy Please let me know if you need the number.