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carrier refusing to fill prescription i have had for 4 years
I have gone through the same thing recently. By law, the carriers must provide a medical reason for denial, however, because New York is corrupt, they just don't. Get your legal ducks in a row. Call your doctor and ask for a letter of medical necessity specifically stating that failure to fill the med leads to opiate withdrawal, and unnecessary medical danger. Also, make sure they note that the medications are part of a pain management plan, detail how long the drug has been prescribed, that all other pain modalities have been exhausted, and that the carriers are arbitrarily denying the meds without providing a medical reason for denial. If possible, find the exact section of the medical treatment guidelines (also available on the website) and cite where these meds are covered for your injury (and ask the doctor to include this language in the letter). When the letter is prepared, be sure to have it faxed to the Board and the carriers (both carriers, old and new) on the same day in the same manner.

Also to cover yourself, file a document called an RFA (Request for Action), available on the Board website. This will tick off your ignorant attorneys (sorry, due for my meds and low tolerance for ambulance chaser attorneys).

But, also please read my post on potential third party lawsuits. If bad things have happened to you like this consistently, you may be someone who can be helped by a RICO lawsuit (for which I have attorneys already retained and need at least two other victims to make a class action from the State of New York).

Also, if the meds are denied and you have other insurance, you need something in writing to provide to your secondary carrier. By law if WC formally denies the meds, the secondary carrier must pay. Provide the second carrier with anything written that confirms denial, or ask your physician to write a letter verifying the denial (if verbal) to get around the insurance companies failure to follow the law.

The other option.... if you are low income, contact the patient assistance program of the drug manufacturer and see if you can get the drug for free......... Often this requires an agreement from your doctor to "hold" the drug, which will be mailed to the doctor, and have you come and get it every 30 days or at some frequency, and a whole bunch of paperwork, but better than living in pain.

Messages In This Thread
RE: carrier refusing to fill prescription i have had for 4 years - ChimarenTaylor - 11-01-2013, 07:33 PM

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