Quote:
Originally Posted by Gabyunbound
Thanks for all the advice and support guys!
I called my pdoc's office and the nurse there said that they do this all the time and to not worry. He said something about insurance wanting to know how long I've been taking it (don't know why). I told him how long because I wasn't sure my pdoc knew; she's relatively new to me and I don't remember if I ever told her -I came to her already having been on Abilify for a couple of years.
Then I got a call from the person in the office who deals with insurance companies and she also reassured me. She told me that she 'exaggerated' things a bit to get the approval, which I suspect might be pretty par for the course. She told me to call CVS by Saturday and ask them if it had gone through.
If it hasn't by then, I'll call my pdoc's office again. It looks like they're the ones who take care of this whole mess. But I wish I were more in the loop and could help with the process; I know best how important Abilify is to my stability. I did tell the nurse and the person in charge of dealing with insurance companies that its the combination of Lamictal and Abilify that has saved me for the last couple of years. Though I think they had already sent the paperwork. If we have to appeal, I will ask to be able to explain to my pdoc's office why it's so important and that I've tried other meds that did not work as well.
If we have to appeal and it takes a while, I might have to buy a month's worth, but I'll use the coupon that has been suggested (thanks!).
I'm scared as heck, but the support here and from my pdoc's office have helped immeasurably.
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The insurance wants to know how long you've been taking it because they don't want to waste their time listening to your pdoc make an argument about destabilizing you. They know your pdoc will argue that going off the med will destabilize you, so they're just cutting out a step and asking it upfront. Basically, "ok, we know you're going to argue about us destabilizing the patient, so just tell us how long they've been taking it. Then we'll decide if the length of time they've been on it will cause destabilization when they go off it." (Insurance companies have doctor's who are trained in certain areas of medicine, including psych medicine, so you are at these doctors' mercy.)
And yep, most doctors exaggerate. It's unfortunately the only way to go. Complete honesty means nothing to insurance companies because they'll find any excuse not to cover the med. Most of them are for-profit and they don't make money by giving everyone exceptions.