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Arduos
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Angry Mar 30, 2012 at 10:15 AM
  #1
So I've been taking Seroquel for a couple of months, and it actually works!!! But, when I go to the pharmacy to get my refill they tell me I have to have my doctor call my insurance agency to get a prior authorization Really??? I haven't had my seroquel for over 24 hours now, and who knows how long I have to wait to get it. I'm already feeling over excited, frustrated and really pi**ed. In other words i'm being thrown into a manic phase cause these people are being ridiculous. I told them after years of trial and error that this is my savior but it's no use. I hope it gets approved, I don't know what I'll do. It was so nice to wake up feeling happy and somewhat normal.... this really sucks

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Perna
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Default Apr 01, 2012 at 10:57 AM
  #2
Did you call your doctor's emergency number; get him to prescribe enough you can "buy" outright, to get you through a couple days until he can straighten out the insurance fiasco? Or, maybe he has samples to get you through. I'd go to the ER if I had to.

Here's how prior authorization works: http://www.consumer-health.com/services/cons_take51.php

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Thanks for this!
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Default Apr 01, 2012 at 11:58 AM
  #3
Ugh. I've been running into this issue with our insurance the past few months. Mind you we've been with this company at least 10 years, and they have never done this until very recently. The first time they did it they were questioning my pdocs prescription for viibryd. I suspect they want prior authorization for any prescriptions for viibryd and I know it isn't "personal " but therein lies the problem. Once they finally got around to looking at my file on a "personal " basis to recognize this wasn't my first rodeo with antidepressants, they recognized my pdoc (you know, the man with the medical degree who knows my case intimately rather than the nameless, faceless person behind a desk who doesn't know me from a hill of beans) was correct to prescribe that med. The problem was that they drug their hills so long making the decision that by the time I finally received my prescription 3 1/2 weeks later my depression was very severe. The insurance found it more important to put me through their bureaucratic maze than to be sure a patient wasn't suffering.

My son has been going through treatment for acne with accutane, a med that is a very highly controlled substance. He had been on it for 6 months and when we went to fill the prescription for the 7th month we were told we needed prior authorization. Dr. sent in the paperwork and they denied the claim saying studies show patients should only need 6 months treatment and then they should be cured. So doc had to make a call to the insurance company's hired hand, I mean doctor, to tell him that some cases like my son's need longer treatment (which seems entirely obvious) and sure enough that time they approved further treatment.

We have excellent doctors and when insurance makes us jump through hoops, delaying treatment and causing conditions to worsen, I find that criminal.
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Default Apr 08, 2012 at 08:16 PM
  #4
Insurance companies often wait to see if someone needs expensive treatment long term, then like to spring unexpected prior auths on the patient. Most patients give up because docs charge a lot to fill out the forms,the patient can't afford to pay the doc for the time, so they give up. Then the company saves money. Thats why my hospital has a huge case management dept to fight the companies to pay for even the gold standard treatments for premature infants.

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Perna
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Default Apr 09, 2012 at 11:06 AM
  #5
I think it is partly Obama-care related; checking to see if there is a generic and making sure the reason for using the more expensive, name-brand drug is legit. Read your insurance policy; they have really changed in the last year or two, I know the extra paper we've been flooded with about the formularies for the drugs has been enormous:

http://healthinsurance.about.com/od/..._formulary.htm

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Stoda
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Default May 01, 2012 at 08:10 AM
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What happened? I hope everything turned out okay?
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overboardgal
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Default May 19, 2012 at 12:36 AM
  #7
Quote:
Originally Posted by farmergirl View Post
Ugh. I've been running into this issue with our insurance the past few months. Mind you we've been with this company at least 10 years, and they have never done this until very recently. The first time they did it they were questioning my pdocs prescription for viibryd. I suspect they want prior authorization for any prescriptions for viibryd and I know it isn't "personal " but therein lies the problem. Once they finally got around to looking at my file on a "personal " basis to recognize this wasn't my first rodeo with antidepressants, they recognized my pdoc (you know, the man with the medical degree who knows my case intimately rather than the nameless, faceless person behind a desk who doesn't know me from a hill of beans) was correct to prescribe that med. The problem was that they drug their hills so long making the decision that by the time I finally received my prescription 3 1/2 weeks later my depression was very severe. The insurance found it more important to put me through their bureaucratic maze than to be sure a patient wasn't suffering.

My son has been going through treatment for acne with accutane, a med that is a very highly controlled substance. He had been on it for 6 months and when we went to fill the prescription for the 7th month we were told we needed prior authorization. Dr. sent in the paperwork and they denied the claim saying studies show patients should only need 6 months treatment and then they should be cured. So doc had to make a call to the insurance company's hired hand, I mean doctor, to tell him that some cases like my son's need longer treatment (which seems entirely obvious) and sure enough that time they approved further treatment.

We have excellent doctors and when insurance makes us jump through hoops, delaying treatment and causing conditions to worsen, I find that criminal.
Yes, with the insurance co's making you do these exceptions just make you more upset, they make you feel like you are doing something wrong, I feel like I am being treated as an 18 yr old. I am 60
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