So my insurance company decided to deny my ambien

I hate insurance companies. I’ve been battling TD and horrible insomnia. Awful. My dr rx’d ambien. With the ambien I was at least able to get a few consecutive hours of sleep. They’ve decided that I don’t meet the criteria for the medication so now I have to appeal.

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Oh man that sucks. I just went though two weeks of hell because my doctor quit prescribing it with no warning, then when I called reinstating it. Insurance companies have no right to make medical decisions, period!

I agree. Insurance companies have no right making medical decisions!

How ludicrous! I hope your appeal is successful.

Thank you all for your support. Unfortunately I leave for Yellowstone in 24 hours and am freaking out about sleeping away from home.

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When i turned 62, my insurance company wrote me a letter, youre too old for ambien now. Gee thanks. Well at least i got twelve years sleep.

I agree with Nammu that insurance companies should not be making medical decisions. Sleep disorders are not trivial matters. Insomnia can horribly disrupt your daily life, as I know first hand. To lose a prescription that you found really helpful must feel awfully disappointing. I wonder if you could pay for Ambien yourself and get it that way. (I don't know how expensive it is.)

Was it a psychiatrist or a primary care doctor who prescribed it for you? If it was a PCP, you might ask for a psych consult. A pdoc might be able to write up a more compelling argument possibly persuasive to the insurance company. There are doctors who specialize in sleep disorders. One of them might bolster your appeal. I recognize that's a lot to go through for what you know has helped you.

We live in an age of diagnosis by algorhythm and treatment by algorhythm. Providers are supposed to follow "decision trees" and slavishly check off lists of criteria. A computer can be programmed to do that. What a computer can be programmed to do does not take into consideration all that should be considered. It's frustrating.

You might try keeping a sleep journal where you document all awakenings. This can give a doctor more hard data for building a case.

Ambien has now become a bllack box medication. Very difficult to get now as it is now believed to do more harm than good. Sleep eating and driving are the hazzards.

Sometimes, the prescribing physician has to file specific recommendation for certain medications. Have you asked your doctor to do so? Or has the pharmacy asked him to do so?

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Originally Posted by Deejay14 Ambien has now become a bllack box medication. Very difficult to get now as it is now believed to do more harm than good. Sleep eating and driving are the hazzards.

Yes it’s true. Ironically even though my psyche is appealing it I just followed up with my sleep study doc. He does not want me on ambien he wants me to try something called bellsorma or bellsomra. Anyone heard of it ?

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belsomra is supposed to reset your sleep cycle I believe. But, the truth is that Belsomra doesn't actually improve your sleep that much. It might help you fall asleep a few minutes faster or stay asleep slightly longer. It didn't work for me at all it was like a water pill. Hopefully it will work for you.

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Originally Posted by Guiness187055 belsomra is supposed to reset your sleep cycle I believe. But, the truth is that Belsomra doesn't actually improve your sleep that much. It might help you fall asleep a few minutes faster or stay asleep slightly longer. It didn't work for me at all it was like a water pill. Hopefully it will work for you.

Well I tried one last night. The copay is 40$ and this doc wants me to try it for a couple of months. My mom and pop pharmacy can’t afford to take good rx coupons but they sometimes take those copay cards from manufacturers so I have to see if there is one. Ambien really didn’t do much beyond a few weeks. It’s like I developed a super tolerance. My doc also wants me to take sleep “course “ through the Cleveland clinic for clinical insomnia which is what he thinks I have rather than it’s origins being psychiatric.

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I really hope you are able to get some rest. I know the pains of insomnia well.

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Originally Posted by Guiness187055 I really hope you are able to get some rest. I know the pains of insomnia well.

My doctor did say I “barely” had apnea- meaning allergies but hes noting it as negligible and recommending a cpap machine. He said extra O2 is good for everyone and he’s had Insomnia patients with no apnea have amazing results. I’m desperate so if my insurance covers it I’ll try it.

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I did the Cleveland Clinic course. I learned some good stuff. The part of the course that is supposed to help reset your sleep is not recommended for people with bipolar so I missed a huge chunk of it. But I'm still glad I did it.