Posted by Ritch on April 2, 2005, at 10:44:51
In reply to Concerta insurance delay!!!, posted by theo on April 2, 2005, at 8:06:22
> I went to pick up my fill from Walgreens and Blue Cross kicked it back saying they have to get reasons for me needing it, etc. from my doctor, could be up to 72 hours!!!
>
> When I call my insurance company (Blue Cross/Blue Sheild) to expedite this, do I say I'm trying this to see if I'm ADD? What should I say to get them to approve it??
I would go ahead and pay out of pocket and let your doctor talk to them. If you call them and tell them you are trying to *see* if you are ADD or not, they probably won't buy that---they would want your doctor to formally diagnose you as ADD and then write the Rx. They may have to formally communicate with your pdoc to approve it-just procedures. When I tried Focalin--my pdoc wrote directly on the Rx the ADD diagnosis. I don't know if that was simply a C-II requirement, or whether it helped with the insurance or not, but they did pay. My current insurance, however, will *not* pay for it though. They will only cover generic methylphenidate. Your pdoc probably knows what to do, just hope that you can get Concerta covered, and you don't get stuck with immediate release methylphenidate.
poster:Ritch
thread:476811
URL: http://www.dr-bob.org/babble/20050330/msgs/478871.html