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Any chance I will get reimbursed for medication from denial and appeals

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    Any chance I will get reimbursed for medication from denial and appeals

    Hi All

    It has been 20 years since my accident and things get so bad with the insurance companies and then the state programs that I now say I work for the state when people ask. I have been on the same medications foe several years and every year Optum RX will deny my meds the 1st of the year and say prior auth needed and or medication is not written for spinal cord injuries. Now the non expensive medications not written for SCI are approved no issue? The expensive ones whole different story. Normally every year its the 2nd appeal and then approved and always the same letters thanking doctor for bringing this to there attention.
    This year just must of been different person stamping the approval and denial letters. I was told by the representative that I could pay out of pocket $900.00 and get reimbursed once approved and I think we both assumed it would be like any other year. Well its been months and I have gone through several appeals and think I may have one left though have not heard anything yet.
    Does anyone know where to turn for help with dealing with a issue like this? They pay for years and I know its all about the money though this has to stop not just for for everyone they do this to. I go from no debt on SSDI to now a large credit card bill thinking it would be approved. Yes my bad, though having it paid for years I was sure this year would be the same. Looking for somewhere to get advice or some agency out there that would assist me in fighting. I need my medication and reimbursement. Now this will be the 1st month I am going to stop because I cant incur any additional expenses. Stooping the medication wont be the end of the world though I just will go from being a productive member of the community to staying home 24/7.

    Any help or advice on where to turn would be appreciated.

    Thank you

    What insurance?
    Which meds?

    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.