Spoke to the nuero who used up three appeals to the insurance company. All appeals were denied. Its an "off label" use to use it for MS patients. that was their final sticking point. My neuro told me that he has now spent a great deal of time, and effort on this, and he simply cannot spend 6 hours a day fighting with these insane folks. He has his nurse continuing to peck away at them, but thus far they are not budging. They are also saying to add provigal would put me over my alloted monthly allowed expense for medicines. I have a golden policy, and it covers many things, but lately they have been real pigs about many things. They have demanded that if you use brand name vs generics, your MD must sign a paper certifying that this is absolutely needed, and not just a patient preference. Many thyroid meds of generic wont work as well as brand name, same for some cholesterol meds, and others but the insurance company must certify in advance that you need this to be brand name EACH MONTH!

This is insane to have this wonderful policy and now have so many restrictions upon it. I used to have 10k per month allowed in medications. now its 5k, but they removed the 3 million dollar limit that was placed on it. So, they made it better, but they also made it worse. They fight you on everything from epi pens to brand names, to off label useage of meds. Its insane that my MD cant say he wants to give me xyz, and have them order it. Even if its 10cents or 10thousand.

Sheesh, everyone talks about how there will be no beaurocrat between you and your MD...there is already a beaurocrat sitting there! Since they already exist I know that to be an untrue statement. If I need surgery, or an in office proceedure, it has to be pre certified! my MD cant simply say "you need your tonsils out" he has to call 20 people and fill out 3 days of paperwork before he can even offer that as an option. They even wanted to know why I was seeing him for a neuro visit when I am considered to be a patient of another clinic. Sheesh!

My MD said he simply cannot continue to peck away at these folks, and that is what they hope for. They hope that they make it so inconvienent to keep fighting that the MD simply gives up. The appeals process is insanely complicated as well. He was turned down for 2 appeals because they didnt feel he met the proper paperwork requirements for "burden of proof" If this was insulin or chemo, we would keep fighting, but a med for fatigue? there are other avenues to try first. Then if we run out of road, we can revisit it.

Thanks for the support.