This is such :bs:

luvmygdaughters

luvmygdaughters

Well-Known Member
My doctor prescribed a medication for Acid Reflux for me in December of last year. I need to refill it this month and guess what...it is no longer a covered medication. It was originally prescribed at the pharmacy in the Bean building. I wanted to transfer the prescription from there to CVS in Leonardtown. That in itself was a P.I.A. Stopped by CVS last night, waited in line 20 minutes at drive thru (no parking spots open except handicap) just to be told that they couldn't get authorization from the insurance carrier. I called them this morning and they advised Cigna stated they would only cover a 90 day supply, I called my doctor, she sent in a prescription for 90 days. I called CVS again, they said now Cigna would not cover 90 days, only 30 days!!!! Ok, I go to my insurance carriers website and learn that this particular medication is not on the approved list. I asked the pharm tech whats the best way to move forward on this, she suggested having my dr. call the insurance company for proper documentation to support the need for the medication. Isnt that what a prescription is???????:cds: Its not like it some damn opiate. ITS HEARTBURN MEDICINE!!!!! If I was to overdose on heroin, they would have narcan administered faster than you could turn around...and it wouldnt cost me a cent and I wouldn't need a damn thing from a doctor!!!!!
 
ginwoman

ginwoman

Well-Known Member
Maybe you should call CIGNA? It's all a PIA I know..... Sounds like you and I travel in the same area and take the same medicine, lol Plus I have CIGNA too :lmao:
 
TCROW

TCROW

Well-Known Member
Usually when someone suggests the “doctor’s office needs to get the paperwork straight”, it means the ICD-9 code (basically a standardized diagnosis code) isn’t correct for your particular situation. At least that’s been my experience. I spent the better part of 18 months in and out of hospitals for cancer treatment and my spouse got really good at dealing with this stuff. It happens a lot.

I now know to always ask my doctor for my specific diagnosis code, though thankfully nothing has been going on of late.

Are the OTC options not suitable for your condition?

Also, my doctors are very sensitive to these types of insurance issues. In many cases my doctor or a PA/nurse practitioner has been my best advocate for these things.
 
luvmygdaughters

luvmygdaughters

Well-Known Member
ginwoman said:
Maybe you should call CIGNA? It's all a PIA I know..... Sounds like you and I travel in the same area and take the same medicine, lol Plus I have CIGNA too :lmao:
Click to expand...

Probably do, Bean building and Shanti building and CVS. I was happy with Cigna last year, this year, totally different story. My doctor said she would call them with the damn documentation. Its just so frustrating.
 
luvmygdaughters

luvmygdaughters

Well-Known Member
I was taking Nexium, however, the doc said she wanted me to start taking what she prescribed because I have an ulcer also. I called the docs office, her nurse is taking care of it for me. I dont know if I could do that, your spouse has more patience than I. It just seem ridiculous, its not like its percocet or oxycodene for goodness sake. Its a strong version of Prilosec or Nexium!!
 
spr1975wshs

spr1975wshs

Mostly settled in...
Ad Free Experience
Patron
Dr I Khan? I've found she really does care about the patient's well being and will help.

Been seeing her since mid-2014 for GERD, been on Omeprozole the whole time.
Have GEHA/United health Care through my wife's job on base.

When I saw her in the fall of 2017 for a refill (we do the 90-day supply thing),
apologized, said I could have called it in. Asked if I had other concerns.
Mentioned the hernias from the Whipple surgery.

She found out that Dr Samdani was in the building and got him to examine me.
Got the opinion that when I'm ready (Whipple surgeon recommended five years clear),
I'm a good candidate for laparoscopic repair.

5 years will be June 2020, so far the hernias have been trouble free.
 
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vraiblonde

vraiblonde

Board Mommy
PREMO Member
Patron
Dealing with bull#### bureaucracies is maddening. I already posted about Maryland trying to cancel my car insurance. :banghead:
 
S

SandieGarry

Well-Known Member
b23hqb said:
I'd like to know as well. Interesting.
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Look up Evergreen health ins. From what I heard, it is the only health ins in the state of Md to be shut down by the courts. Yep, we had it a t work. They were actually pretty good. We had a $30 Dr office visit copay, now it's $100. Geesh
 
luvmygdaughters

luvmygdaughters

Well-Known Member
Well, the doctors office just called. They contacted Cigna and the medication is not covered by Cigna at all. Lovely... Doc is trying to find something else to put me on. It ticks me off, I can get Nexium or Prilosec but, I cant use my FSA funds to pay for it, unless I have a prescription...its a catch 22
 
LightRoasted

LightRoasted

If I may ...
If I may ...

luvmygdaughters said:
Well, the doctors office just called. They contacted Cigna and the medication is not covered by Cigna at all. Lovely... Doc is trying to find something else to put me on. It ticks me off, I can get Nexium or Prilosec but, I cant use my FSA funds to pay for it, unless I have a prescription...its a catch 22
Click to expand...

How's about changing your diet and maybe exercising? Be proactive and responsible, with your health. Just a thought. Or if you really don't want to do that, pay out of pocket, Amazon delivers. You can get a 4-pack of 28 pills each for $35.90. Generic is even cheaper.

https://www.healthline.com/health/gerd/diet-nutrition
 
terbear1225

terbear1225

Well-Known Member
LightRoasted said:
If I may ...



How's about changing your diet and maybe exercising? Be proactive and responsible, with your health. Just a thought. Or if you really don't want to do that, pay out of pocket, Amazon delivers. You can get a 4-pack of 28 pills each for $35.90. Generic is even cheaper.

https://www.healthline.com/health/gerd/diet-nutrition
Click to expand...

how's about not assuming that someone isn't already being proactive and responsible with their health just because they need a medication. Would that be your response to someone who needs insulin for diabetes? DOn't know if it was intended that way but your comment comes off as very condescending. Just a thought.
 
vraiblonde

vraiblonde

Board Mommy
PREMO Member
Patron
terbear1225 said:
how's about not assuming that someone isn't already being proactive and responsible with their health just because they need a medication. Would that be your response to someone who needs insulin for diabetes? DOn't know if it was intended that way but your comment comes off as very condescending. Just a thought.
Click to expand...

:high5:
 
RoseRed

RoseRed

American Beauty
PREMO Member
terbear1225 said:
how's about not assuming that someone isn't already being proactive and responsible with their health just because they need a medication. Would that be your response to someone who needs insulin for diabetes? DOn't know if it was intended that way but your comment comes off as very condescending. Just a thought.
Click to expand...

:yay:
 
LightRoasted

LightRoasted

If I may ...
If I may ...

Geez. All these high 5's and thumb ups. I only write from experience. Used to have reflux bad, especially at night while asleep. Horrible waking up to that, and I mean horrible. Changing to a good and proper diet completely stopped it, as well as started an exercise regime. Never looked back and absolutely no more reflux. So if you've changed to a proper diet, and exercise, and are still having reflux, then you have a much more serious issue such as a hiatal hernia, or are pregnant, or you are fat, smoke, and continue to eat and drink stuff such as alcohol, carbonated beverages, chocolate, citrus fruits such as oranges or lemons, coffee or tea (regular or decaffeinated) fatty or fried foods, foods containing tomato, such as spaghetti sauce, salsa, or pizza, garlic and onions, mint, spicy foods such as those containing chili or curry. Or you are taking aspirin or ibuprofen, some muscle relaxers, or certain blood pressure medications. You want to rid yourself of reflux? Then stop eating any and all processed foods. Eat only whole natural unprocessed type foods, lose those extra 50 pounds, if you have them, stop smoking and drinking, and exercise regularly. So instead of attempting to chastise me for only, initially offering some wisdom, take responsibility for your health. Prilosec, and like drugs, only suppresses the problem, it does not fix the problem, which is diet. These drugs shut down the proton pump, an enzyme involved in the production of stomach acid. They shut down a normal body function. There are newer studies now that show a link between these types of drugs and chronic kidney disease, in which the kidneys lose their ability to filter blood effectively. If you want to play Russian roulette with your life by taking pills, with serious side effects, to stop a normal body function instead of changing your diet, go right ahead.
 
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