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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by NCC4200 on March 23, 2001, at 18:41:20
I have been diagnosed with severe ADHD, accompanied by veryt rapid cycling bi-polar, very slight tourette's syndrome, chronic or acute depression, and a few others, lol. I just switched Insurance carriers to Medicare / Secure Horizons, and I cannot get my Adderall covered. I have been on it for 3-4 years with no side effects, but according to Sav-ons Drug store, Secure Horizons will not cover adderall for ANYONE OVER 18. WHY NOT!!!! ADHD is a permanent chemical Imbalance in the brain, and Adderall < or ritalin/dextro-amphetamine and other class 2 stimulants > are routinely Rx'ed to adults.
Why is the insurance company denying me what is needed, just cause my age is over 18?
Anyone else have these problems?
Anyone have an Idea on how to win this fight?Thanks
Posted by Sulpicia on March 23, 2001, at 22:15:26
In reply to ADDERAL vs. Insurance Companies, posted by NCC4200 on March 23, 2001, at 18:41:20
> Hi and sorry you're going thru this. First, contact your prescription insurance carrier
and confirm what the drug store told you. I cannot believe that what they told you is correct.
If you were narcoleptic, what would you do? Die behind the wheel of your car? The policy doesn't
make sense. It *may* be a policy of the drug store. Lots of pharmacies hate to deal with schedule II
drugs.
After getting your insurance carriers' policy on this drug, preferably in writing, have the prescribing
doctor write to the insurance company stating that the drug is medically necessary. I know lots of
mom of kids with ADD/HD who have prevailed like this. The insurance companies inevitably back down
in the face of medical necessity.
Post this to the attention of CamW. He should have some good advice for you.
Medicare? I know stimulants are prescribed off-label for certain situations like after strokes; perhaps
the prescription would be filled if the diagnosis were different?
I'll dig around a bit for you.
Good luck.
S.
Posted by kazoo on March 23, 2001, at 22:41:46
In reply to Re: ADDERAL vs. Insurance Companies, posted by Sulpicia on March 23, 2001, at 22:15:26
> After getting your insurance carriers' policy on this drug, preferably in writing, have the prescribing
> doctor write to the insurance company stating that the drug is medically necessary.^^^^^^^^^^
This advice is good and will usually work. The very same situation happened to a friend of mine who has ADD and tried to get her Dexedrine prescripton filled. She has a 20 dollar co-pay but the insurance company would not honor the script, so she had her doctor CALL the insurance company who, very professionally, ripped them out a "new one" (if you catch my drift).
Let me give you some info re. insurance companies/the gov't and stimulants, SPECIFICALLY the amphetamines. Since the 1970s, the Federal Government has been trying to get ALL amphetamines off the market, declaring them medically useless, addictive, etc. etc. They failed miserably because of the hard work of the American Narcoleptic Association. You can thank the ANA for working to keep this genre of drug around. I don't know if this is still true, but amphetamines were banned in Wisconsin in the 70s, and I believe Sweden has banned all stimulants, targeting in on Ritalin.
This is the same government that freely allows, condones and even encourages the use of alcohol and nicotine.
(a stimulated) kazoo
Posted by NCC4200 on March 24, 2001, at 3:43:54
In reply to Re: ADDERAL vs. Insurance Companies :: NCC4200, posted by kazoo on March 23, 2001, at 22:41:46
> > After getting your insurance carriers' policy on this drug, preferably in writing, have the prescribing
> > doctor write to the insurance company stating that the drug is medically necessary.
>
> ^^^^^^^^^^
>
> This advice is good and will usually work. The very same situation happened to a friend of mine who has ADD and tried to get her Dexedrine prescripton filled. She has a 20 dollar co-pay but the insurance company would not honor the script, so she had her doctor CALL the insurance company who, very professionally, ripped them out a "new one" (if you catch my drift).
>
> Let me give you some info re. insurance companies/the gov't and stimulants, SPECIFICALLY the amphetamines. Since the 1970s, the Federal Government has been trying to get ALL amphetamines off the market, declaring them medically useless, addictive, etc. etc. They failed miserably because of the hard work of the American Narcoleptic Association. You can thank the ANA for working to keep this genre of drug around. I don't know if this is still true, but amphetamines were banned in Wisconsin in the 70s, and I believe Sweden has banned all stimulants, targeting in on Ritalin.
>
> This is the same government that freely allows, condones and even encourages the use of alcohol and nicotine.
>
> (a stimulated) kazoo
It's amazing how many Doctors and Insurance Companies < so called "professionals" >, Do not know what the hell they are doing. The last group of Doctors totally messed up several times, First starting me on Lithobid < Lithium >, without ordering blood tests to establish a baseline and monitor the titrations of LIthium into the system. Then after I complained thru patients rights < a totally useless group of people >, the doctors came up with a new policy. Anyone whom is prescribed Adderall, must submit to drug testing before any scripts are written. ( And it is the County Mental Health Department also.)
Now that I am enrolled with a new insurance company, they wont cover the Adderall, which I have been taking for over 4 years.
Dont they know that it is morally wrong to < supply your own colorful metaphor, limit to 4 letters >, abruptly stop giving medically necesary meds, especially to someone that is Sever ADHD. Not to mention what it does to your system. In less then 4 months, they have totally destroyed any progress I had made in the last 4 years.And now that I have new insurance, I cannot get the meds I have been prescribed for so many years - And i even went to the same pharmacy that i have been going to for all these years. Sav-ons was nice enough top print out the prescription final review, showing the insurance companies comments:
" 76 - EXCEEDS PLAN LIMITS, MAXIMUM PATIENT AGE OF 18 "
Did I miss a physiological metamorphosis when I turned 18, that automatically adjusts the Brain's Chemistry to correct the biological and / or chemical imballance.
Does anyone know if this is a case of Discrimination, or if it is against the Americans with Disabilities Act? If so, where does someone get help.........
Posted by pat123 on March 24, 2001, at 12:44:16
In reply to ADDERAL vs. Insurance Companies, posted by NCC4200 on March 23, 2001, at 18:41:20
I just switched Insurance carriers to Medicare / Secure Horizons, and I cannot get my Adderall covered.
Most HMO's will accept an appeal from the doc stating that this is a medically nessacery med.
Remember that with an HMO and any serious condition, you have to advocate for yourself.
Do not accept a no and always ask to appeal.
In it never over if they say no, but you should expect them to always say no.Pat
Posted by blackjack on March 25, 2001, at 13:47:47
In reply to ADDERAL vs. Insurance Companies, posted by NCC4200 on March 23, 2001, at 18:41:20
See if you doc will put "narcolepsy" as the diagnosis instead of "ADD"...
Posted by Noa on March 26, 2001, at 6:34:17
In reply to Re: ADDERAL vs. Insurance Companies :: NCC4200, posted by kazoo on March 23, 2001, at 22:41:46
Yes, I have had that problem with previous insurance--pdoc wrote that it was medically necessary and they covered it, although the process had to be repeated every 6 months.
This is the end of the thread.
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