Insurance sucks

Anyone else have problems getting reflux meds approved through your insurance? We have been going round and round with them for a week. Our pedi recommended upping the chunky monkeys reflux dosage of Prevacid from 15mg a day to 22.5 mg a day based on his weight. The insurance will only approve 30 (15mg) pills in 24 days which leaves us 6 short per 24 days and would make us have to be super attentive to when it is time to refill the Rx. It would also have us paying over $120/mo on reflux perscriptions (and that's WITH insurance!).

On a side note, anyone else on that high of a doseage? I vaguely remembered the adult doseage being 30mg?

 

We used Zantac and they would only fill a 3oz bottle at a time. That meant we had to go back before 30 days were up to get it refilled.

 

Our insurance only paid for 3 months worth of Zantac....because after three months they thought that whatever you were using Zantac for should have fixed itself <_< . So it was then costing me $50 a month, so I tried weaning DS around 8 months and luckily he was ready and no longer needed the medicine.

I wished I could have left DS with the insurance people who decided that policy so they could listen to him cry and then get spit up on numerous times....maybe then they would change their dumb policy for other people dealing with babies with reflux!

 

I would call the insurance company again, or better yet have the pedi's office call. If its medically-necessary they shouldn't be giving you a hard time about this. :hug:

 

I've been known to call the insurance company with a screaming baby in-hand.

They usually send us in circles - the pedi office calls them, they get told it's all set. We call the pharmacy to arrange a pick-up, we get told it's not covered. We call insurance, who calls the pharmacy, who calls the pedi, who calls us. Etc. Last time I got so fed up that when the kids got all worked up, I didn't even try to calm them. I just picked up the phone and said something along the lines of:

"Yes, I was hoping you could help my underweight son who is in pain and afraid to eat? In all the red tape, people have lost sight of the fact that there is a sick child waiting for his medication that his doctor - the one that actually sees and treats him - has deemed this medically necessary. So if you could help me or connect me to the authorization department so they can hear precisely what they are doing to my child, I would really appreciate it."

Wouldn't you know, the prescription was ready an hour later?

Fighting this battle again today, to try a different reflux med. I hate how much red tape there, while he's suffering in the meantime.

 

My DS is on the Prevacid solutab (15mg) twice a day and it costs me $272 a month! And that's my portion I pay AFTER insurance! It really sucks! Plus, we had a difficult time getting the insurance to approve the Prevacid twice a day & then getting our stupid pharmacy to fill it. Prevacid does have a rebate program so I get $25 off each month's prescription---not great, but I'll take it! We can't really afford another $272 a month, but the Prevacid is the only thing that works for him & makes him a happy, healthy, big 17 lb boy. So I just wind up putting it on my credit card & I guess we'll worry about paying it off later. Everytime I go to the pedi's office, I clean them out of their Prevacid samples so that helps a little bit too.

 

I had a really hard time getting my son approved for Previcid. I hate insurance companies! Who are they to tell you what is good for your baby! My poor son had to try different things before they would approve him. It's terrible that they do this to people.

My son is still on 15mg. We never discussed increasing the dose.

 

Back when Piper needed Prevacid, the company that makes it offered a prescription card that allowed you to get $25 back each month from them (or something like that). I can't remember the company name, but I bet you could find it online and see if they still offer this program.

If Prevacid is too expensive you could try Prilosec. We switched and liked it better, and have a $30 dollar copay each month, which isn't too bad.

 

We are in the same boat with regard to my daughters previcid and our horrible insurance company... it costs us a fortune AFTER insurance, and we are always shorted because of dosage increases the insurance co. doesn't agree with...

I love the Mother who let them listen to her screaming child :clapping: !!!

 

QUOTE(cat419 @ Oct 3 2008, 09:29 AM) [snapback]1009928[/snapback]
I've been known to call the insurance company with a screaming baby in-hand.

They usually send us in circles - the pedi office calls them, they get told it's all set. We call the pharmacy to arrange a pick-up, we get told it's not covered. We call insurance, who calls the pharmacy, who calls the pedi, who calls us. Etc. Last time I got so fed up that when the kids got all worked up, I didn't even try to calm them. I just picked up the phone and said something along the lines of:

"Yes, I was hoping you could help my underweight son who is in pain and afraid to eat? In all the red tape, people have lost sight of the fact that there is a sick child waiting for his medication that his doctor - the one that actually sees and treats him - has deemed this medically necessary. So if you could help me or connect me to the authorization department so they can hear precisely what they are doing to my child, I would really appreciate it."

Wouldn't you know, the prescription was ready an hour later?

Fighting this battle again today, to try a different reflux med. I hate how much red tape there, while he's suffering in the meantime.


Wow. Did I log in under a different name and post this???

We so do the circular finger game here, too. I have mastered three way calling with my pharmacy and the insurance for just that reason. And the screaming baby in hand was what got the meds approved last time.

 

And thanks to several of you for mentioning the rebate program. It is definately something we will look into. Even before our dosage was increased we were spending over $80/month on just prevacid. I am not really complaining, as I would give my last nickel to keep them from screaming out in pain and the Prevacid has worked wonders for us. We have also several times had to pay for the whole Rx up front without insurance while we were working through coverage issues and at $7 a pill I appreciate the $300 the insurance kicks in or negotiates down.

I keep hoping we will grow out of it which I am sure we will at some point. I am just ready for some point to be today.

I am also a little worried that given how many folks are dealing with reflux here I didn't hear one single response on having > 15mg/day dose of the Prevacid Solutabs.

 

I replied about having > 15mg of Prevacid.... My DS takes 15mg of Prevacid twice a day, so that's 30mg total. 15mg worked but only for about 18 hrs or so & then the spitting up and screaming would start again. So we started doing 15mg in the morning & 15mg at night & it's worked great for us.

 

QUOTE(jkk922 @ Oct 3 2008, 03:16 PM) [snapback]1010553[/snapback]
I replied about having > 15mg of Prevacid.... My DS takes 15mg of Prevacid twice a day, so that's 30mg total. 15mg worked but only for about 18 hrs or so & then the spitting up and screaming would start again. So we started doing 15mg in the morning & 15mg at night & it's worked great for us.


Sorry I completely spaced that. I read it as 15mg split into twice a day as that is what we have been doing until lately.

How much did your son weight when they upped him to that dosage?

 

He weighed about 10-11 lbs when we upped him to Prevacid twice a day (was almost 3 months old). The pedi thinks he metabolizes the medicine really fast & that's why one solutab wasn't helping. Two Solutabs have made a huge difference! He's 17 lbs now & has turned into a really great eater. It's a wonderful thing!