Dftsteph, my h and I have had similar difficulties with our insurance, including with a cancer med for my h.

This is what worked for us: I called and talked to the doc's medical assistant. If your pdoc doesn't have one, you can talk to whoever answers the phone, except the answering service.

Tell them what's going on, without ranting. The provider is trying to change the doc's prescription. The doc can fill out some forms that explain the need for the drug and the dosage.

Doctors are used to doing this. In my case, the situation was settled in my favor in less than one day. In my h's case, it took a week, and I also wrote an appeal. His medicine costs $1400 a dose (saved his life.)

After they'd hassled with me on three meds, I was able to call them on the fourth one and they approved it over the phone and even apologized.

You can also find out what the appeal process is and appeal it to the provider yourself. Again, don't rant. The best approach is to say that without this drug at this dose the risk of relapse and expensive hospitalization is very high.

Even if you've never been in the hospital, you can honestly say that you've been taking the med at the doctor's prescribed dose and it's relieved symptoms and made you more functional. If the regimen is changed, the risk of hospitalization is high and that would cost a great deal more than the medication.

Unfortunately, cost is what the insurance company cares about. If you can effectively argue it's cheaper to keep you on the medication, you have a chance of winning your appeal.

But first call your doctor's office and tell them what's happening and ask them if they can intervene with the insurance company. Most doc's will.

If you have an insurance handbook, look up the appeal process. If you decide to appeal the decision yourself, make sure you follow the process as outlined in the handbook to the letter.

The approvals are usually good for a year so you might have to do the same thing again a year later.

The first time they denied me I was totally freaked out and didn't know what to do. After reading the handbook and talking to the doc's staff, each denial is just an annoyance now. So far, nothing's been turned down for good. We just have to justify these really expensive drugs.

We just received notice that my h's medication has been approved for another year. The doc's receptionist filled out the form and it was okayed within a week. But my h had to go in and personally ask her to fill it out because it had been sitting on her desk for a while. That's worth about 18 grand. And his life. So we're willing to jump through any hoop they put in front of us.

I hope your doc will straighten this out for you.