New insurance is a real headache!

[ladybug162]

So I’m kind of freaking out right now! I recently took a new job because it was a better fit and better salary. But I’m finding out this new insurance is a real pain!

I had my 6 month follow up with my neuro yesterday which went well. I was originally going to have him refer me to another neuro that’s in my network since he is no longer after changing insurances. However, he is one of very few ms specialists in my area that I know of and I’ve been with him for several years now...and I love him to death because he really takes the time and actually explains things to you so that you understand. So I decided just to pay the extra money to see him (an ms specialist) rather than switch to a regular neuro that would be in my network.

I’m surprised though that he didn’t put in an order for my annual mri to be done. October will be a year since my last one. However, he explained that they recommend getting one every 12-18 months instead of every 12 months especially for those who are doing well like myself. He said it had something to do with the contrast dye and how long it stays in the system etc. so they space them out a bit more I guess so you don’t get contrast overload? Not really sure if I understood him correctly on that though. I’m just glad I’m doing ok....no flares etc.

Anyway, the reason I’m freaking out is because I found out today that my new insurance denied my Tecfidera and my Imitrex that I take for my migraines. This is not good because I can’t function without my migraine medicine and as for the Tecfidera.....well I’ve done really well on it so far and don’t want to stop taking it! Been taking it for over 5 years now. And I definitely can’t afford to pay for these meds out of pocket!

So I frantically call my doctors office today and leave a message for him. He told me at my appointment yesterday that I should still be able to get my Tecfidera at no cost like I had been doing. I’m just waiting to hear back now. I just don’t want to run out of my meds. I literally have one pill left of my migraine medicine so I’m trying not to take it unless I’m like on my death bed.

I’m just starting to regret changing jobs now. 😩

[gargantua]

$0 copay

Call Biogen’s Financial Assistance 1-800-456-2255 and ask them if you still qualify for the $0 copay program with your current insurance. I hate that we have to go through this worry! Biogen will help you find out.

Good luck,

Rox

[ladybug162]

Call Biogen’s Financial Assistance 1-800-456-2255 and ask them if you still qualify for the $0 copay program with your current insurance. I hate that we have to go through this worry! Biogen will help you find out.

Good luck,

Rox

Thank you so much!! I will call them TODAY!

[Jules A]

I'm not sure if this applies but in many cases the insurance companies require ridiculous paperwork from your physician's office as a prior authorization to justify giving us expensive medications. Its a total time glut for our doctor's administrative staff but in most cases will get approved eventually.

[ladybug162]

I'm not sure if this applies but in many cases the insurance companies require ridiculous paperwork from your physician's office as a prior authorization to justify giving us expensive medications. Its a total time glut for our doctor's administrative staff but in most cases will get approved eventually.

Yep, it’s definitely a prior authorization thing. Been dealing with this since last Monday.....back and forth on the phone with the doctors office, the pharmacy and my insurance. The pharmacy first told me my insurance card was not valid. I call my insurance and they tell me there is nothing wrong with my card. I get that all straightened out for them to tell me I need a prior authorization. Finally my doctors office said they submitted the auth, but it still was denied. Then I get another story saying the pharmacy never received it. I’ve just been so frustrated and upset that I just came home and cried. Today I just went to another pharmacy and told them I did not have insurance because I may as well not with all this headache. Anyway I was able to get my imitrex for just under $15 there without insurance. Still working on my Tecfidera. If I had a choice I’d never choose this insurance again!

[gargantua]

Yep, it’s definitely a prior authorization thing. Been dealing with this since last Monday.....back and forth on the phone with the doctors office, the pharmacy and my insurance. The pharmacy first told me my insurance card was not valid. I call my insurance and they tell me there is nothing wrong with my card. I get that all straightened out for them to tell me I need a prior authorization. Finally my doctors office said they submitted the auth, but it still was denied. Then I get another story saying the pharmacy never received it. I’ve just been so frustrated and upset that I just came home and cried. Today I just went to another pharmacy and told them I did not have insurance because I may as well not with all this headache. Anyway I was able to get my imitrex for just under $15 there without insurance. Still working on my Tecfidera. If I had a choice I’d never choose this insurance again!

Hi Ladybug,

What happened when you called Biogen? Their rep works directly with your insurance and your doctor and then lets you know if you need to set up $0 copay. Call them soon!

All the best,

Rox