Jump to content


Photo

Ihelp: Insurance Approves Just Half My Nuvigil Dosage

insurance prescription living with N

  • Please log in to reply
7 replies to this topic

#1 raouf

raouf

    Member

  • Members
  • 2 posts

Posted 24 January 2013 - 01:38 PM

Hi All,

 

I have lived N for the past 8 years. I started with Provigil and moved to Nuvigil 12 months ago.  My dosage has been 500mg Nuvigil (2 tabs of 250mg) a day.  The 500mg dosage of Nuvigil combined with 20mg of Celexa ( for cataplexy) and a healthy lifestyle  allows me to live a "normal" life. I just switched to AETNA insurance with my new employer and Aetna DENIED the prescribed dosage to only approve250mg a day.   My doctor appealed and was turned down.   I am writting an appeal to Aetna, but I have very little faith of a positive outcome.

 

IF denied, I will go to the courts in the hope that the courts will oblige Aetna to accept the dosage.   Has Anyone ran into a similar experience that can provide me with some advice?

Are there standard appeal letters I can use to file my appeal?  What supporting document should I include?

 

I consider Aetna's behavior to be CRIMINAL.  Aetna knows that I can get into an accidentat any time  and seriously hurt myself and others, but they still deny me the meds.    There is something wrong with our Healthcare system and Justice system where minors are sent to jail for stealing snicker bars and insurance companies are free to commit 2nd degree murders.

 

I welcome your input and advice to get through this situation.

 

Thank you,
foufou

 

 

 



#2 Rrrapture

Rrrapture

    Member

  • Members
  • 23 posts
  • Gender:Female
  • Location:Los Angeles

Posted 06 January 2014 - 08:06 PM

I'm having problems with insurance covering the amount of my night medication (Sonata) that I'm prescribed. It's pretty frustrating. The doctor's request for prior authorization has just been denied. Now I'm in the process of figuring out if the doctor should fill out the form differently, or what. Insurance is Anthem Blue Cross PPO. (California).

 

What's the status of your case?



#3 raouf

raouf

    Member

  • Members
  • 2 posts

Posted 02 April 2014 - 12:49 PM

Hi, 

 

Sorry for the long hiatus.  I had my doctor appeal it a couple more time in vain. I tried to take them to court but I was doing lots of travel and had too much on my place.  At this point,  I am paying Out of Pocket for the extra 30 tabs, which is what Aetna and all these pharma companies want right? for us to pay $24/per pill.   I also tried buying from India. I received the meds but I think they're sugar pills at best.    I am still searching for a legitimate foreign supplier...more on that. 

 

I am having my doctor go through the process all over again as I am tired of paying so much.    Other than that, life if good :)

 

How about you?

 

Ciao



#4 Lousyskater

Lousyskater

    Member

  • Members
  • 30 posts
  • Gender:Male
  • Location:Rio Vista, CA
  • Interests:Computers, Electronics, Electric Guitar, Gaming

Posted 11 April 2014 - 12:39 AM

Makes me happy my company got rid of Aetna last year.



#5 chichi

chichi

    Member

  • Members
  • 4 posts
  • Gender:Female
  • Location:Indiana

Posted 18 April 2014 - 01:23 PM

I have Aetna and am on 500 mg nivigil. It is covered. Granted it takes a letter from my dr each year to recerrify it's the only one that will help me. It literally takes just one phone call and it gets approved. I wonder what is with the Aetna you have.

I was paying 800+ a month but now it's 350 for 3 months worth.

I really hope it works out for you

#6 chichi

chichi

    Member

  • Members
  • 4 posts
  • Gender:Female
  • Location:Indiana

Posted 18 April 2014 - 01:24 PM

Forgot to add that Aetna is my health insurance however it's Medco/Express scripts that handles the scripts. That is probably the big difference

#7 Hank

Hank

    Member

  • Members
  • 992 posts
  • Gender:Male

Posted 18 April 2014 - 01:29 PM

What is and is not covered has less to do with Aetna and more to do with the specific coverage which your employer has negotiated.

#8 chichi

chichi

    Member

  • Members
  • 4 posts
  • Gender:Female
  • Location:Indiana

Posted 18 April 2014 - 02:55 PM

True bit it's absolutely nuts how different it can be.





Also tagged with one or more of these keywords: insurance, prescription, living with N