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Insurance frustration


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#1 linzieluv

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Posted 19 October 2007 - 03:44 AM

I complained to doctors for five years about having extreme fatigue before anyone even thought of a sleep disorder. I had the night/day sleep study and the specialist and my doctor agree that I have a sleep disorder. I have all the symptoms of N but cataplex. My doctor and specialist thought provigil would be a good choice for me, my insurance did not. My doctor got me some coupons and I have been on it for the last month and its been really nice. I only have four days left of the medication and my insurance still doesn't want to cover it. My doctor has written my insurance company letters and they responded that 1) there was not enough evidence that I had N and 2) they would only cover ritalin because provigil could be habit forming. Isn't ritalin addictive? You would think it be cheaper covering the medication then ordering more sleep studies or having to pay for a medical review. I love my new job, but if I start feeling like I did before the provigil, I wont be able to do it. Is there anything more I could/should be doing to fight my insurance? I am tired and angry, but I am scared too. Also I am worried because if I stay in my job, I'll get new insurance. Will I just have to fight the same battle with the new company? I heard that some insurance companies do not treat exhisiting conditions for a year. Any advise or anyone who has gone through something similar?

#2 Marinaki

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Posted 19 October 2007 - 04:14 PM

Hey there that sucks about your insurance company... Luckily I had Blue Cross who took care of all my tests and sleep studies and medicine. Go to Provigil's manufacturer's website...

http://provigil.com/...mbursement.aspx

there is information for medication assistance.

I hope this helps.

#3 merrymom1013

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Posted 19 October 2007 - 06:01 PM

With our old insurance, they wouldn't approve provigil unless treatment with adderal or ritalin had been tried first. My daughter was on adderal, then switched to provigil without a problem. (After a few months she asked to switch back to adderall). Can you check out the insurance company policy and work it out with your doctor? Maybe a week or two trial of ritalin would get you ok'd for provigil.

#4 linzieluv

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Posted 26 October 2007 - 02:06 AM

Thank you, that website did help. I have blue cross blue shield and never had a problem before. I bought a months worth out of pocket, and if I get it coved later my pharmacy will give me back the difference of the co-pay and full amount.

#5 jlconrad

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Posted 07 December 2007 - 02:12 PM

I am having this issue as well. I was with United Healthcare under my dad, and they covered it fine. I have been taking 300 MG for about 6 years now. 200 was not enough. I graduated and got a job and now I have Anthem Blue Access (PPO), and they will only cover 200 MG. I can't survive on just 200 so I don't know what to do anymore. I am worried that they won't budge and I will have to pay out of pocket. It's almost $200 a month. Anyone have suggestions for me on how to get Anthem to cover it?