Community Chat

[Moonchilde]

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@newjersey wrote:

@AKgirl2, I'm not sure if it was a pharmacist or a tech.   I just called CVS back now, spoke to the same person, and told her I really can't understand why/how an insurance company call tell anyone how much medicine he/she should take.   The CVS person told me she has heard of this before.   I know I haven't.   I'll call my doctor and insurance company Monday and see what happens.  Now I'll fret and be anxious about this all weekend.

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However the person who called you phrased it, what they're trying to say is that the insurance company won't pay for the prescription if the prescription is 2 pills per day - they will only pay for one pill per day. You can have the prescription filled but YOU will have to pay the full cost.  Your doctor would have to write the ins co a letter to justify the two pills per day, and even then the insurance co can still deny it.

[Q4u]

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@cherry wrote:

I stopped dealing with the mail order pharmacy we have though my husbands  retirement.  I got a call from a pharmacy telling me I needed to get my statin refilled

I told him I quit taking them , and  I was having bad side effects.  He kept me on the phone lecturing me ,about the importance of taking this drug.  I should have hung up on him. He wasn't my Dr.

If he would have had the muscle pain I did he ,wouldn't have taken them either.  They just want every penny they can get

I now fill my scrips at a brick and mortar pharmacy

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This is outrageous!  I quit Statins as well after 18 mos of horrific side effects.  Interestingly I told my doctor about the side effects and got poo-poo'd and told how much I needed them.  I titrated down myself (Simvastatin).  But a PHARMACIST?   

[cherry]

@Q4u  It was express scrips, and I have heard nothing but bad stuff  about them.  I use medicare, and probably pay more, but I don't care.  They will never get another penny from me

[Marp]

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@hyacinth003 wrote:

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@Marp wrote:

@newjersey, I haven't yet read the responses to your post but yes this is happening.

My nephew has MS and the insurance company only wanted to allow one dose of a medication he has taken three times a day for a long time.

It was a battle but with his doctor's help he was able to get his entire prescription refilled.  That is the good news.  The bad news is when it comes to next month's refill they don't know if he will have to go through this again or be able to get the full prescription.  No one could answer that question for him.

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Yes. He can get 3/day, but they can decide to only pay for 1 per day.  He would have to pay the additional cost for 2 more unless he can negotiate differently with them.

Sorry for someone with MS to get any hassle.  Since my mother had it, I wouldn't want anyone denied payment for something helping them.

It's all a very big business.

Hyacinth

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In a prefect world he would be able to pay for the additional medication but being on disability makes paying several hundred dollars a month impossible even if the medication helps keep him functional.

[Q4u]

And this is how DH ended up on creams that are NOT covered by insurance.  They won't cover the expensive, very effective creams.  Yes to the lower grade, less expensive creams.... that really don't do anything and we watch his Psorisis get worse.  

He initially got these high end creams from Kaiser (Calif) when we were par of their program (through his work).  But CVS Caremark through Social Security denied these creams. 

I just remembered an insurance outrage from 20 years ago.  My father was dying in a Convalescent hospital.  He was on a respirator and couldn't move.  The staff ordered an ambulance to take him to the hospital, with a "bagger" (someone who manually gives him air)... and the staff to move him.  

When the bill came the insurance denied paying for the ambulance run as well as the extra staff to take care of him.  Why??  They said it was because he had a daughter with a car (me!) who could drive him to the hospital!!  

Sure.... I'd steer with one hand, bag him so he could breathe with the other hand.... and when we got there I'd just carry his 6'1" frame over my shoulder to the ER....

I had just lost my Mother and my emotions and nerves were raw.  It's unbelievable that there are people in charge out there that have no idea what they're doing or who they're affecting....  only the bottom line.  

[PurpleBunny]

@Q4u  Argh, reading that brought up old anger in me. We had taken my son to the local hospital in extreme pain, he was only four. They made us wait for hours  - pumped him full of morphine and told us it was "just his back."  Finally, I refused to take it anymore  because I was watching them take full-grown adults with twisted ankles and they were leaving my four-year-old, writhing in pain in the lobby.  I said that we were leaving to drive him into Children's Hospital in Boston. They REFUSED to let us drive him and insisted that he take an ambulance.  They even threaten to call the police if we left without him being in an ambulance!   So off we went in an ambulance. I got a $2000 bill for the ambulance - insurance refused to pay and said it wasn't necessary!  Oh, and It turned out, it wasn't his "back" - it was an extremely rare hernia, so rare, they had never seen one.  He was hospitalized for a week. 

[viva923]

this is a way for the insurance company to take over our doctor's place.

The insurance company likes to spread its wings and show people who the boss is, insurance company or your personnal doctor.

[CareBears]

@newjersey After reading the posts mentioned in this thread it is making me nervous, my husband just started a new job and the insurance provider is CVS Caremark, sounds as if they are buggers to deal with, I will let my doctor and his nurse duke it out with them!

[Qcloudy]

Having worked in a pharmacy for several years, I can say that this is not uncommon. For example: one of my meds I need 20mg once in the morning and once at night. Insurance won't cover. However, they will cover a 40mg which I split to get 20mg for each dose.

Sometimes the insurance will not cover a med because it has been shown that in that amount it "could" be overdosing. The doctor can asked for a prior authorization and then the insurance will probably pay.

Those are but two examples that I could give.

Even if it is one of the techs that calls, they do so at the instruction of the RPh. Most often, the RPh does the calling. Our pharmacy was so busy, it was usually a tech that relayed the message. However, if the patient/customer desired to speak to the pharmacist, the RPh always complied.

HTH

[Moonchilde]

I have Silverscript, the CVS Medicare Part D supplement. I have never had them tell me I need to "change what I take." I have had them hand me a filled Rx and tell me the insurance company won't pay for it, and did I want it ($400) anyway? No...no, I didn't want it anyway. I got my doctor to prescribe it "creatively" and it is now paid for.

I used CVS for 15+ years while I was working, and never had anyone suggest to me that I "needed to change my medication (or dose)."