Posted by stjames on September 26, 2000, at 23:51:24
In reply to Re:Paxil v Serzone--insurance , posted by ksvt on September 26, 2000, at 19:52:19
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> james - excuse me for being a little dense, but how did your hmo justify not covering effexor? I was under the impression that it was pretty mainstream stuff. Is it that much more expensive than the SSRIs? ksvtJames here....
HMO's, as a cost containment procedure, have what they call "formalary". This is a list for meds they will pay for. In general this is not a bad idea, doc's do not need acess to evey antibiotic to treat people. It is different for things like the psuco meds. Both the AD's I take are non-formalary and are the olny (and when I say only I mean EVERY AD out there, excet MAOI;s) It has been a tap dance with the HMO to get these meds. The %(&%(& HMO pays a 3d party to process Rx approlals. The HMO does not have a problem letting me get these meds, it is getting this info to the 3d party so i do not have to pay retail for 60 150 mg Effexor and 15 30mg Remeron and wait 3 months for the HMO to pay me back.
So the first time I the I went without meds and sleep for a week and the HMO customer service was no help I called my doc and asked to be admitted as a danger to myself. I got my meds. I also got the special phone # for overrides on Rx's that only the doc were to use. next time it happened I used the "special number" and they were real pissy till I told them I was a crazy person and
b4 i blew my brains out becuse of no meds i would come over to their office and mow them down. One can be very convincing with no sleep for a week, crashing off Effexor. Cilck...I had a manager on the phone. Meds...no problem ! I told them in the future I would just admit myself, at a cost of $2,000 and hold them resopnsible for all mental trauma, anyone I killed, ect. For about a year I would call them a week b4 I refilled and I had no problems. Then they said they fixed it so I did not have to warn them. I have had no problems for a year now.It is sad that I pay $420/mo and have to resort to these tatics.
james
poster:stjames
thread:216
URL: http://www.dr-bob.org/babble/20000926/msgs/45344.html