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    Hurting and mad

    please explain this - I've been on Fentora and Duragesic for 5/6 months now. Monday I take the Fentora rx and it's denied because I don't have friggin CANCER. I almost WISH I DID so I'd be out of my suffering. My bone is a hot painfull burning source of agony. My insurance refills Dilaudid rather than my Fentora. What's that?? I look it up online and get all these street drugs sites. It doesn't work well and I'm so upset and in so much pain. Why are insurances so fucking cheap? Isn't this what they're for??

    M.

    #2
    hopefuly can you appeal it, you can usually appeal it a couple levels, your doctor will have to write a letter of necessity
    cauda equina

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      #3
      Call your insurance company and ask to speak to your case manager. If you don't already have a case manager, request that they assign you one. They will spend more time to understand your needs. At least in our experience (with Regence BlueCross Blue Shield), our case managers have been quite helpful.
      - Richard

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        #4
        Both of the above posters are right in their advice to you.first,you need to contact your Rxing doc and have him or her fill out a certain document that details the actual need for this specific med,and no other will do,just make sure he states that this specific med itself is the only one that helps,no others will work for you.then speak with your Ins co if you have to.when i have had to do this in the past with like three seperate meds that have been Rxed for me over the years that were not in my ins co formulary or an off label use,my doc just wrote the ins co about it and i got them all three times.tho it took about anywhere from a few days to about a week with one of them they did come thru for me.

        sometimes,espescially when trying to treat the freakin bizarre types of conditions and the ungodly pain we live with everyday,very specialized meds are needed.if your doc can justify this for you,your battle should be won.all you really need is your docs backing on this.he has to justify the need to your ins co.i wish you tons of luck with this and hopefully you will be able to obtain it.what IS fentora anyway,i have never heard of this drug before?hang in there and plaese let us know how you are doing,Marcia

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          #5
          I had a feeling that with the creation of the Medicare part D drug program we were headed for "managed care" medications as well. Usually insurance follows the governments lead. I got a letter for Darvocet that I hadnt used for pain in quite sometime but actually still had an active prescription for. Darvocet is the lowest of the totem pole so to speak of the narcotics. However, I havent recieved a letter for any of the other pain drugs I am on.....I hope they dont wait until I dont have any to pull this crap with not refilling any of them.

          Soon we'll just be calling our insurance company to see if we can get refills on our medications....what a scary thought huh?
          T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

          My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

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            #6
            my DR did write a letter of necessity, it was DENIED. I called the insurance company requesting a social worker, they don't have 'em. They did, however, tell me it had been officially denied due to malignant cancer pain absence and told me the next step is to write a letter to the appeals board, who can then take their goddamn time apparently - 60 days and probably deny it again. When I asked the insurance rep who was to compose the letter she said it didn't matter - WTF? I don't know if I'll bother it's so aggravating. Dilaudid is gross. Makes my stomach turn and my body sweaty and ill-feeling. God I HATE insurances.

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              #7
              In composing my draft, I'm having difficulty with the salutation. Which is better: To Whom It May Concern or Listen Up You Motherfuckers? This makes me want to get the most expensive stuff they have and keep fucking around with the dosage at their expense. Cheap bastards.

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                #8
                Originally posted by Michaela
                In composing my draft, I'm having difficulty with the salutation. Which is better: To Whom It May Concern or Listen Up You Motherfuckers? This makes me want to get the most expensive stuff they have and keep fucking around with the dosage at their expense. Cheap bastards.
                I think listen up mf ....would get more attention. You sure as hell got a laugh out of me. I think I pulled another muscle, time to go stretch again!

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                  #9
                  Originally posted by Michaela
                  ...I called the insurance company requesting a social worker, they don't have 'em...
                  Did you use the magic words "case manager"? That's important. Our case managers have been RNs.
                  This is a case of the square peg and round hole. Sorry you have to go through it, but hopefully you can grind the hole enough to fit through.
                  - Richard

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                    #10
                    Michela,

                    I found a statistic last year that I hold onto: 75% of all claims are denied, 75% of all appeals are won. It pays to appeal.
                    My blog: Living Life at Butt Level

                    Ignite Phoenix #9 - Wheelchairs and Wisdom: Living Life at Butt Level

                    "I will not die an unlived life. I will not live in fear of falling or catching fire. I choose to inhabit my days, to allow my living to open me, to make me less afraid, more accessible, to loosen my heart until it becomes a wing, a torch, a promise. I choose to risk my significance; to live so that which comes to me as seed goes to the next as blossom and that which comes to me as blossom, goes on as fruit."

                    Dawna Markova Author of Open Mind.

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                      #11
                      Thanx for the advice, everyone. I just wrote an appeal letter and have an appointment with my doctor Wednesday afternoon. I'll ask him then for a written statement. I hope it gets reversed. I hope I covered everything adequately in my letter. I can't even put into words this neuro pain that sends me to bed every day. I'll let you all know the outcome.

                      Michaela

                      If you guysthink of addtl info I should include please write it here!

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                        #12
                        there is always the option of just showing up in someones office and stating your case(maybe inflict some pain on them to show them where yours is???) to the idiots,thats if you can actually find the bastards who denied you.thats just really a sick thing to do espescially when it comes from your doc.i wish you TONS of luck and do hope you get it okayed soon.hang in there,marcia

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                          #13
                          I agree, Marcia. I got a coupon for 28 - a free box. I'm waiting on my appeal. I'll let you know. You're very sweet & knowledgable, BTW

                          M.

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