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    Insurance Company Claims They

    don't have to advise you of their denial of a prescription medication.

    I'm still trying to get Provigil (or Modafinil is fine). Doctor sent prescription to pharmacy two weeks ago. Pharmacy says they're waiting on insurance company.

    I called health insurer today and was told they have denied the prescription and they don't have to advise anyone they have denied it. Told me if I wanted to know if it was approved or not I had to call them and the phone call is the only advise/confirmation I will get. Of course, they added in the comment that I can purchase the medication myself - sure, no problem, it's only two grand a month!

    I can't believe the insurance company doesn't have to advise you in writing. Anyone familiar with this? Last June my neuro sent in a pre-authorization form - I never heard anything.

    #2
    Hi its2much,

    That's not uncommon, it has happened to me before. Your insurance company should also give you with the reason it was denied. They'd prefer you didn't pursue it any further, but enlist the help of your neuro and appeal. (And appeal again if that's denied.) Find out the time frame you can expect a decision (usually 30 days for first level appeal) and make sure you call them if you or your neuro don't get an answer by that time.

    Pre-authorizations have to be renewed, so once you do get approved (hopefully, you will), you will most likely need to get pre-authorization again sometime in 2016. (But, it's easier once you've already been on it.). You should find out when that is ahead of time, so the process of reauthorization gets completed in plenty of time.

    Good luck.
    Kimba

    “When you change the way you look at things, the things you look at change.” ― Max Planck

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