Insurance problems

[lauralls1]

I am a caregiver for a relapsing MS patient. He is having soooo much trouble with his insurance (UHC). He is currently out of his med (tecfidera) due to another hold up. This time it happened when he was told by Briova he needed a prior authorization from his dr since it had been a year. His dr. faxed the paperwork to UHC. This is where everything has stalled for an entire week. Today he called Briova and was told that UHC has denied his coverage. When he called UHC they told him it was pending and it would take 14 days. So that's 2 more weeks for UHC to make a medical decision. Is anyone else having this problem with their insurance co.?

[Iona60]

Tell your Dr. that you are out of meds and ask what you should do.

[lauralls1 in reply to Iona60]

Talked to the dr office this morning (they called) and they let me know the ins (UHC) has now approved the prescription. They said this happens every year without warning to the customers or drs. So next year we will start the process sooner. Thank you !!!

[Iona60 in reply to lauralls1]

So glad this is working out for you. I hold my breath every Jan that I'll be able to get my MS meds filled.

[Juleigh21]

Call Biogen! They CAN help!

[lauralls1 in reply to Juleigh21]

Will do next time! AND start this preauthorization on my own sooner.

[erash]

lauralls1 MSSA might be able to help. Jesmcd2 might be able to give you the contact #

[lauralls1 in reply to erash]

Thanx

[Jesmcd2 CommunityAmbassador]

Hi lauralls1 call [phone] ext. 154 and see if MSAA can help you.

mymsaa.org

Also

nationalmssociety.org

800-344-4867

Someone out there has got to be able to help!

Thanks for bringing it to my attention erash

Let us know how it goes Laura

Jes🌠

[lauralls1 in reply to Jesmcd2]

Talked to the dr office this morning (they called) and they let me know the ins (UHC) has now approved the prescription. They said this happens every year without warning to the customers or drs. So next year we will start the process sooner. Thank you !!!

[lauralls1 in reply to lauralls1]

Briova said they would do 1 day shipping instead of 3 day!! Hope this is true!!

[Christopher04]

Yes same thing with my son. Copaxone. Fidelis is his insurance.

[lauralls1 in reply to Christopher04]

Good Luck!!

[lauralls1 in reply to Christopher04]

Maybe start the PA next year on your own. That's what we will try.

[Jesmcd2 CommunityAmbassador]

Christopher04 check out my other post in this line. ☺. It has all the numbers and websites for you!

[lauralls1 in reply to Jesmcd2]

Thanx!!

[DogMamma]

lauralls1, hello, I am a caregiver, too. Husband's pain Doctor RX'd a new drug(patch) for inflammation and we are in process of Prior Approval with UHC Medicare Advantage(husband is not yet 65)! Guess I had better give those guys a call . It has only been a week, but now I am worried. Thank you for heads up. Have had problems with PA's, before. But that was with Blue Cross/Blue Shield. Prayers and hugs.

[lauralls1 in reply to DogMamma]

Thank you and good luck!!

[DogMamma in reply to lauralls1]

Sadly, letter received yesterday, PA NOT APPROVED! Same old same old - not approved by FDA for use requested. The fight continues.

[punterstein]

Absolutely call Biogen. They WILL help. I had trouble getting my Avonex approved from UHC and Biogen sent me medication while the whole thing got sorted out by my insurance company.

[lauralls1 in reply to punterstein]

So good to know!!

[Bygonelines]

I work with getting authorizations from insurances for my job. I and the other ladies on my team HATE working with UHC. They are terrible for getting auths. It usually requires multiple phone calls to them to get them moving. Definitely call Biogen. They will assign someone to pester, er..Call UHC daily to get them moving faster and they should be able to send you some samples to tide you over. Your doctor may also have some samples or a starter kit he can give you to tide you over.

Good luck!

[bavery207 in reply to Bygonelines]

@Bygonelines anyone who does that job should be candidates for sainthood. My hat is off to all of you!

[Bygonelines in reply to bavery207]

Thank you! Most companies are not as bad as UHC.

[lauralls1 in reply to Bygonelines]

Thank you!!

[Pbailz]

Honestly I have had and then almost 7 years. I had Avonex mail ordered from the company for free for almost nine months because even with my teaching salary which was between 30 and $40,000 they said I didn't make enough for the co-pay. Then I went a couple years having to pay deductibles but it was the same when I went for sixto 9 months on a program for Aubagio to be mailed to my house for free. Now that I started Nudexta for pseudo bulbar, it was over $100 at the pharmacy & over $1,000 for the mail order of 3 mo supply, the drug company website tho has a coupon so that you will never pay over $30 a month. I would definitely definitely start with the drug companies

[bavery207]

@Lauralls1 if you arte in the US

[bavery207]

@lauralls1 If you are in the US you could contact your states Bureau of Insurance, or this would not be as quick as it seems you would need, but you could also contact the office of your US Senator or Representative. I understand they often work on insurance issues.

Please let us know what does and does not work for you as we may all be in a similar situation at some point.

[itasara in reply to bavery207]

I am glad you finally got positive results, Lauralis1. This is really despicable the situations that some up with insurance. I don't know anything about UHC but there should be a way to dispute this whenever it is a problem. This is typical so I have heard that many insurance companies. Did you get a reason for denial? I would certainly find out-if they will even give you a logical answer next time.. Do you know if anyone else was denied? Are they just slow or incompetent? Or are they paying way too much for medications? I know when many of us got refused for the 3x/wk Copaxone, when it first was available. the responses I got form BCBS were ridiculous. I wrote my congress reps, and the attorney general of my state, , and anyone else including MSAA I could think of. Not sure how much it did but about two or so months later BC gave in. Oh I made a comment to them on their twitter page and that got me a response from them. They didn't like negative press. I didn't give in to any of their excuses. Your doctor should get on their tail as well!

[CalfeeChick CommunityAmbassador]

Just a suggestion, check with the manufacture of the tecfidera. It's the same company that makes Tysabri. They were going to put me on the tysabri at first and Biogen was going to assist me with the medication. I wound up not getting on the meds, but please check with Biogen as your patient may get some assistance.

[itasara in reply to CalfeeChick]

Three is usually an income level one has to quality for to get the help. I don't know what it is, but even if you exceed the amount it is LOT to pay. I know finally after all these 11 years can now order three months at a time instead of every month. Saves me about $50== drop in the bucket!

[edibleflower]

Contact BIOGEN SUPPORT 800.456.2255 and talk to them about getting medication to get you through.

[doveflyfree]

Often times my pharmacy helps with prior authorizations. I can't believe the doctors office isn't pushing the issue !!! Don't give up keep calling everyone until he gets approved. Call MS Foundation and MS Society they might be able to guide you. The sqeeky wheel gets attention!!! Keep calling!!! I'm sorry!!!