I think I spelled it right, But this is whats going on. Up to 3 months ago I was able to get my meds on a somewhat resonable time frame. But I go in to get them to find out they are being denied " wc ". Well last month I called my ncm and my adjuster they seemed to be honest and said they would try to fix it. Well instead of waiting I had them turn into my PI, well long behold again the same thing. So I called again and they called me back and said the pharmacy was filling them while we spoke. They say my wc checks came from them but my meds were paid by a 3rd party ic. Well thats means nothing to me for I dont understand why they would do that.
What do you's think...? Does their story hold any water or are they just playing with me. Because they try to asure me it aint them just sitting back saying no to all my meds.
Also I take ambien to help me sleep-- hospitol put me on cause I would have panic attacks/ flashbacks and kept waking up. Now wc says I dont get them paid for now cause they dont think I need them anymore. jack @sses.
Bronco
The insurance company sent me a pharmacy card from Express Scripts.
Would this be what you are asking about?
A couple of years ago I went to fill a wc script and my personal health insurance company rejected paying for it so I had the pharmacy send the bill to my employer.
A couple of week later I received the Express Scripts pharmacy card in the mail.
Bronco, You can File for a "Utilization Review" and a Panel of Dr.'s will look Over Your Medical Case and Meds., and Write a Decision to the w/c Hearings Judge to Make a Decision on. That was done to Me by the Defense, and they Tried to Stop a lot of My Meds. but the Review was found in My Favor, and they had to Pay. I believe You have an Attorney, am I Correct? If I am, Talk to them and See if there is a Program that will Supply Your Meds. while Your Case is being Fought. I'm in Pa., and I had My Meds. Covered by Innoviant Pharmacy while My Case was being Battled, and I Won, and they had to Pay $25,000.00 in Back Meds. I Hope there is a Company like that in Your State. My Best to You, and Please Keep Us Informed!!
They are only denied when someone tells them to stop payment. So, if you think their telling you the truth, re-think.
Still in Limbo, yes I do have a lawyer and will ask about that. I do see my surgeon and my infectionist disease DR in a month. They are thinking of stopping antibiotic and run blood work. And thanks for the info and I do hope they have a Pharmacy like that here.
Bummer, thanks I think I will try that with my employer it never hurts to try. They have put preasure on IC before maybe this will work.
Thanks again.
Bad Boy, I do have that thought in the back of my head. Now that I am back to work they probably will start jerking me around. Thanks.
bronco, it is possible that the medication part of the insurance is contracted out to another party...often insurances companies will do this, and then the one you have becomes the "mother or umbrella" insurance company. However, eventhough your w/c insurance may contract out certain services they are still the ones liable to assure that you have your medications. Another thought about why the medications were denied can be related to documentation issues or lack of on your doctors part. Certain drugs require different types of documentation to justify their use, and ambien happens to be one. Often insurance companies will deny any medication that can not have a generic drug yet due to copyright issues for the first 10 years, because of its cost. WHen a doctor orders a drug that is not a generic he or she is responsible by law to justify why a generic is not appropriate for your health at this time. He must document the benefits and how the risk are minimal versus a generic drug that is similar. I hope this helps. I had prescription authorization/license from 1997-2003. Then I gave it up because it has so many responsibilities and ties to doctors that I didn't want to have. Love Red
I had an express scripts card also. When I went to my IME and the doctors report came back that I was not depressed from work they stopped paying for cymbalta. Also the doctor said he has never had his patients on percs and they stopped paying for all those also.
So did you have a IME done lately?? That is when they can stop paying for meds. if another doctor for the IC says you do not need them. Sad but true. Now my personal insurance pays for my meds. each month. By right it should be wc.
Just an FYI. Express scripts was the company that was used where I worked last as an adjuster. I had more calls about prescriptions being denied by me as the adjuster, when in reality, I had already told them they were authorized. They do not always enter things correctly in their computer, and there are certain drugs (usually pain meds) that they need to put in their system a certain way so that it doesn't always kick out a denial. Also used to call pharmacies directly and tell them it was OK, but the person answering the phone, didn't always make the notations so their response was "WC didn't approve this"
No wonder I'm not doing this anymore! But, don't panic or think they are denying until you know for sure. Sometimes it's just a miscommunication.
But Sparkey,
Surely you were glad to hear that you weren't depressed right ?
Just thought I would update, I did go back to pharmacy the next day and sure enough they were filled and all covered. I guess sometimes not blowing to much hot air at the adjuster some times work. We will se at the next refill.