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Insurance Letter Says They Won't Cover It....

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Posted 7/27/2014 12:50 PM (GMT -5)
Well its Sunday and my appointment was Wednesday. On Monday I'm calling for an appointment because I'm pissed now. My PM Dr will prescribe something else and if I can't get it filled the same day I'm not sure what to do after that. All of this because my insurance on July 1st says whatever tier medicine requires pre-authorization.

More to come tomorrow. I'm using more percs per day than I'm use to which means I'll be really short by day 30.
Posted 7/28/2014 10:46 AM (GMT -5)
Well it's Monday and I've stuck to my guns to get this resolved.

I just called the PM Dr and told the receptionist a quick summary and that I needed to speak with a real person and of course got voicemail. I quickly told the story but I have zero faith of a phone call back today. I did mention if not resolved today please call me back so I could make an appointment.

I'll be happy with an appointment at this point. He can change my Nucynta medication and also give a 10 day supply of something else because I'm going through my percs quickly.

They are really forcing my hand. Surgery has not been on my radar because of how bad my first one went. Now I'm considering looking for a new surgeon and having fusion surgery again. I've gone through pain management to avoid surgery but after several days of what I'm going through to get medications filled I think getting fixed and ditching meds all together has become an option now. I guess United Healthcare would rather pay for a $100,000 surgery instead of $100 medication. That's good business practice right there.
Posted 7/28/2014 10:46 AM (GMT -5)
Another update, called the Doctors office and a person I knew answered so she provided the information I needed.

So the Doctor office said they sent the form again. I called the pharmacy and they told me they tried twice to fill it with no success. Then I called my insurance and they told me their pharmacist / consultant has it in que which can take anywhere from 7-15 days.

I got a little frustrated on the phone. Just tell me yes or no already. Luckily this medicine isn't life or death because I'd be dead. Its impossible to get medication in Florida.

I talked to my wife about fusion surgery and we decided to start looking for a surgeon by the end of the year.

Post Edited (jpjr50) : 7/28/2014 1:54:42 PM (GMT-6)

Posted 7/29/2014 1:42 PM (GMT -5)
I called my PM Dr to make an appointment but they only had August 6th. I explained my situation once again and they gave me Thursday afternoon but I'll be doing some waiting.

I'm so done with all of this. I don't like having to rely on other people with all these rules and regulations. I don't like relying on meds.

This has been the best thing that's happened because I've been really clear about taking the next step. We are planning for surgery.
Posted 7/30/2014 4:40 AM (GMT -5)
Please check the manufacturers website for an assistance program,discount card,coupons,anything to help bring the cost down some. Also check your cellphone carrier since several of the big carriers have a discount card. Walgreens has a plan also and there's a fee but worth the amount for the discount if they cover the nucynta.

If you use any of the rental places such as RAC,Aaron's,etc they have a pharmacy discount card for customers.

Does the insurance company you use have a local office and if it does hand carrying those papers from the Dr may be your best bet. Also gives you a chance to one on one and face to face with someone even if the decision is not theirs to make.
Posted 7/30/2014 2:18 PM (GMT -5)
Good points Vickie.

Final Update:

The Pharmacy called me today and the Nucynta was filled. So the dilemma is do I pick it up and cancel my Dr appointment or don't pick up the script and go get the Nucynta changed?

After talking it over with my wife we decided just to pick up the Nucynta and have it changed on my next appointment Aug 20th. I was too exhausted after this ordeal to get another med and hope this one gets filled (could be another week or more without meds again).

Well that's all for now, onto the next issue. Whether or not to schedule another fusion surgery.
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