For once the Delay in my meds is NOT my insurance's fault!

[sos219]

WOW.. I was supposed to start my Gilenya 1/22 but got a message from my Dr office on 1/20 that they didn't get apporval for it so they canceled my appointment

On 1/21 I called my insurance company to find out why it wasn't approved yet, they were great they said that it had been "reversed out" because it needs prior auth and needed to be submitted through their pharmacy so she transferred me to the pharmacy.

They said that all they received was a form for financial assistance they needed the script in order to approve it.

I called my Dr office to tell them what I was told, they seemed confused about it. I think because most of the time the Drug companies handle the insurance part of the meds.

I went one step further and called Gilenya (i have had 0 contact with them which seemed weird) They said they don't send the script until your first dose and that they had it in their system that I have had prior authorization since 1/7 (just as I thought) they said that they would look in to it further. Also the reason they hadn't contacted me prior to this was someone marked on my sheet that I was being taken care of by a third party!

The pharmacy called me back and confirmed that everything was all set and there was no reason for the office to have canceled my appointment!

The Office called me to let me know that I am all set of starting Gilenya on 1/29. They have my first dose starter pack in the office already and everything. They apologized for the confusion there was a lot of people involved in getting me on it and things just got confused ... :-(

I"m kind of annoyed about my Doctors office I feel like this is mostly their fault.



So first dose of Gilenya will be 1/29

[laurasari]

I am glad you got this straitened out. I also never heard of the dr getting the insurance information. But that's what I was told from my Drs assistant. that's the way he does it. I called Gilenya and they said some Drs do it that way. They have yet to receive the form from the Dr. Dr said awaiting approval from insurance. I will be out f the country for 2weeks on Thurs and another week away in the US. I told them that more than 2 weeks ago but I am thinking nothing will be done before I leave and then we will see what happens while I am away
Good luck
Laurie

[lstrl]

That is so annoying. I'm glad you got everything straightened out though. I had the same problem when I started Avonex and it turned out to be my dr's office as well. Now that I'm in an MS clinic, they are really good about taking care of that kind of stuff. It certainly takes a lot of the stress away since I know that they're very experienced with getting people on MS drugs and know how to work it to get an approval.

I hope this really works for you. I'm on day 4 now and I had some nausea on day 2, but nothing since then.