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Old 06-27-2021, 10:10 PM   #1
sarahsweets
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Default So my insurance company decided to deny my ambien

I hate insurance companies. Iíve been battling TD and horrible insomnia. Awful. My dr rxíd ambien. With the ambien I was at least able to get a few consecutive hours of sleep. Theyíve decided that I donít meet the criteria for the medication so now I have to appeal.

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Old 06-27-2021, 10:16 PM   #2
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Default Re: So my insurance company decided to deny my ambien

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!
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Old 06-27-2021, 11:48 PM   #3
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Default Re: So my insurance company decided to deny my ambien

I agree. Insurance companies have no right making medical decisions!
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Old 06-28-2021, 02:40 AM   #4
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Default Re: So my insurance company decided to deny my ambien

How ludicrous! I hope your appeal is successful.
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Old 06-28-2021, 02:55 AM   #5
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Default Re: So my insurance company decided to deny my ambien

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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Old 06-28-2021, 03:10 AM   #6
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Default Re: So my insurance company decided to deny my ambien

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.
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Old 06-30-2021, 11:29 PM   #7
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Default Re: So my insurance company decided to deny my ambien

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.
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Old 07-17-2021, 08:01 PM   #8
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Default Re: So my insurance company decided to deny my ambien

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.
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Old 07-21-2021, 12:03 PM   #9
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Default Re: So my insurance company decided to deny my ambien

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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Old 07-21-2021, 01:33 PM   #10
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Default Re: So my insurance company decided to deny my ambien

Quote:
Originally Posted by Deejay14 View Post
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 itís 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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Old 07-21-2021, 03:35 PM   #11
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Default Re: So my insurance company decided to deny my ambien

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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Old 07-21-2021, 04:18 PM   #12
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Default Re: So my insurance company decided to deny my ambien

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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.

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 canít 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 didnít do much beyond a few weeks. Itís like I developed a super tolerance. My doc also wants me to take sleep ďcourse ď through the Cleveland clinic for clinical insomnia which is what he thinks I have rather than itís origins being psychiatric.

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Old 07-21-2021, 04:23 PM   #13
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Default Re: So my insurance company decided to deny my ambien

I really hope you are able to get some rest. I know the pains of insomnia well.
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Old 07-21-2021, 06:06 PM   #14
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Default Re: So my insurance company decided to deny my ambien

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

My doctor did say I ďbarelyĒ had apnea- meaning allergies but hes noting it as negligible and recommending a cpap machine. He said extra O2 is good for everyone and heís had Insomnia patients with no apnea have amazing results. Iím desperate so if my insurance covers it Iíll try it.

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Old 07-21-2021, 06:52 PM   #15
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Default Re: So my insurance company decided to deny my ambien

Quote:
Originally Posted by sarahsweets View Post


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 canít 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 didnít do much beyond a few weeks. Itís like I developed a super tolerance. My doc also wants me to take sleep ďcourse ď through the Cleveland clinic for clinical insomnia which is what he thinks I have rather than itís origins being psychiatric.

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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.
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