Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)

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Old 01-13-2014, 06:45 PM #1
alaska49 alaska49 is offline
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Default Problems with insurance

I have had the same insurance for years thanks to my dad and his work and they have payed for everything but since the new year everything has changed. Many of my meds I rely on the most they refuse to pay saying that they will never cover it such as ketamine which is whats keeping me living, and other meds the co-pays have have more the tripled. I have never had issues with the insurance and dont know what to do now with all the increases, i will most likely have to ask my dad to help pay the extra 4-5 hundred a month for all the meds. before I didnt need any help as co-pays for most were a dollar but now they are over 50 dollars and like the ketamine nasal spray was 4 dollars now wont at all cover so have to pay the 350 out of pocket but without it I go down hill so have to do it. dealing with insurances just make things so much harder when they look for every loophole in the book and excuse not to to pay for what they should.

Samantha
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Old 01-13-2014, 07:18 PM #2
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Originally Posted by alaska49 View Post
I have had the same insurance for years thanks to my dad and his work and they have payed for everything but since the new year everything has changed. Many of my meds I rely on the most they refuse to pay saying that they will never cover it such as ketamine which is whats keeping me living, and other meds the co-pays have have more the tripled. I have never had issues with the insurance and dont know what to do now with all the increases, i will most likely have to ask my dad to help pay the extra 4-5 hundred a month for all the meds. before I didnt need any help as co-pays for most were a dollar but now they are over 50 dollars and like the ketamine nasal spray was 4 dollars now wont at all cover so have to pay the 350 out of pocket but without it I go down hill so have to do it. dealing with insurances just make things so much harder when they look for every loophole in the book and excuse not to to pay for what they should.

Samantha
With the recent changes in distributing health care for all of us, the entire paradigm and rule set have changed. For most of us, what we had and enjoyed before is now a thing of the past. Of course the ins. co's will always bend the rules to benefit themselves, the origin of the problem is one step removed since there are now "new" rules that they and physicians must follow. Sucks...
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Hopeless (01-14-2014)
Old 01-13-2014, 10:15 PM #3
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Old 01-14-2014, 12:17 AM #4
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Default Not Alone

Quote:
Originally Posted by alaska49 View Post
I have had the same insurance for years thanks to my dad and his work and they have payed for everything but since the new year everything has changed. Many of my meds I rely on the most they refuse to pay saying that they will never cover it such as ketamine which is whats keeping me living, and other meds the co-pays have have more the tripled. I have never had issues with the insurance and dont know what to do now with all the increases, i will most likely have to ask my dad to help pay the extra 4-5 hundred a month for all the meds. before I didnt need any help as co-pays for most were a dollar but now they are over 50 dollars and like the ketamine nasal spray was 4 dollars now wont at all cover so have to pay the 350 out of pocket but without it I go down hill so have to do it. dealing with insurances just make things so much harder when they look for every loophole in the book and excuse not to to pay for what they should.

Samantha
Dear Samantha,

I am so sorry to hear you are having this problem but you are not alone. MANY insurance companies have removed a lot of their drug coverge from their formulary. The entire health insurance system AND health CARE industry has been turned on its ear, effective January 1st. Changes have been made to Medicare, to private insurance, individual policies, group policies, and Medicaid. NO health insurance of any kind has been left untouched. Changes range from minor to major. These changes in "coverage" in turn effects CARE and COSTS, too.

Some people MAY qualify for other discounts or other programs for assistance but many will not qualify for these programs. You will have to check them out to see if your particular situation will allow you to take advantage of some of these discounts.

The assistance programs are offered through various sources, from the pharmaceutical company, your state, and other venues. Some disqualify you from assistance if you have insurance. Some will supplement you if you have insurance. It is not a blanket discount for all. I have looked into several different assistance programs and did not qualify for any of them yet several of my meds have been removed from the formulary. I am just on my own to pay full price for some of them. I wish you better luck with finding assistance to make up for the changes to your insurance coverage.
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Old 01-14-2014, 01:36 AM #5
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Quote:
Originally Posted by alaska49 View Post
I have had the same insurance for years thanks to my dad and his work and they have payed for everything but since the new year everything has changed. Many of my meds I rely on the most they refuse to pay saying that they will never cover it such as ketamine which is whats keeping me living, and other meds the co-pays have have more the tripled. I have never had issues with the insurance and dont know what to do now with all the increases, i will most likely have to ask my dad to help pay the extra 4-5 hundred a month for all the meds. before I didnt need any help as co-pays for most were a dollar but now they are over 50 dollars and like the ketamine nasal spray was 4 dollars now wont at all cover so have to pay the 350 out of pocket but without it I go down hill so have to do it. dealing with insurances just make things so much harder when they look for every loophole in the book and excuse not to to pay for what they should.

Samantha
And the worst of it all, the one who's crammer of these "new rules" at us is untoucable...
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Old 01-14-2014, 09:20 AM #6
alaska49 alaska49 is offline
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Thank you all for your info. Russel I do agree the ones who meds all these horrible changes are the ones left the untouchables which isnt right. I do have medicare and medicaid as well but their payments have changed also. i dont know what to do cause I survive on my SSDI check which is 750 and paying for over 30 meds a month with higher payments will be hard. I will have to ask my dad or grandpa to help or I wont make it.
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Old 01-14-2014, 09:56 AM #7
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So sorry to hear of all you're going through. It's bad enough, this monster we're dealing with,now it's getting harder and harder to survive through no fault of our own...
Good luck please...
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