Thanks for everyones response and suggestions, they are very apprecited.

Well, I got up this morning all ready to conquer the insurance prescription deliema and set them straight! I then had my cup of coffee and after 1 hour on hold for the pharmacy div of the insurance co - and STILL listening to that elevator music with the annoying lady stating every 3 minutes or so "we will be with you very shortly" - my phone battery had died and I came back to earth, pinned my insurance card to my bulletin board and threw my son's darts at it. I did feel better! Who needs Cymbalta if you have darts?
I then called them back on my other phone and I got customer service again and they stated the pharmacy division were a "little back logged" this morning. Duh, you think? I tried to tell the Customer Service my plea of help - but they could not help me - I had to talk to the pharmacy dept. So what is the terminolgy "customer service" for? Sorry - I am just a little heated still! I ended up calling my pain management dr and got the receptionist who whole heartedly took my plea and stated the nurse would call me back today. Yes you are right - they did not call me back today. I do understand that they get backlogged. At least she seemed to know what I was saying and more or less made the statement the dr needed to fill out the form stating I really needed these prescriptions. I guess the insurance company thinks we like taking these pills just for the heck of it - huh? Again- I apologize for the sarcastic remarks and this is so long. Its just that I was starting to be able to sleep a little bit. I have tried Trazadone and had a reaction to it, as well as Lexapro and Celexa. As for the Lyrica - I cant take Neurotin but I know there are older types out there. Guess I have to wait for my pain mg dr tomorrow to get hold of me. In the meantime, hubby took the darts away from me. Hehe.

Lindkaye,

Go ahead and vent. That's partly what this forum is for. We can get things off of our chest. We have all been there.

I'm glad your husband confiscated your 'missles'.

Mike

doctor call the insurance and get a "prior authorization"
for you.

Most insurances will do it with a doctor's urging.

You don't have to go without. You just have to make some noise of the right kind!

Yes, do that. And call the insurance, ask to talk to a supervisor.

Tell him/her which meds your doc has RX'd for you, and that you will accept no substitutes - you have tried the alternatives and they do NOT work.

If the insurance does not want to pay, your next move will be to get online and contact the State of WA Department of Insurance to file a complaint. Tell them you are going to do that, too. They hate the idea of being buried under a ton of state paperwork. Give them a chance to make things right.

I have had to file complaints with ODI (my state's Ohio) and believe me, the problem was solved within days.



And now, all I have to do is mention ODI, and the insurance knows I mean business.

I am not asking for any benefits I'm not covered for, but they WILL pay for stuff I am supposed to get, and I am supposed to get my meds.


So are you.



Good luck.

They may need to talk to your pain guy anyway. Most insurance companies WILL budge if they are given docymented proof (your chart) that what they will pay for will not work. Had to do the same with my husband's stomach meds-called many docs from way back when my insurance changed and they suggestion OTC Pepcid-uh, hello, like we hadn't already thought of that! The doc can also help by getting "pre-approval" and pushing it through the system. However, he will also be on the phone going through the same elevator music, so if he agrees, send him a card-you know what he had to go through.
Hope that helps
Lori Lee