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GM's thread about nothing (41 Viewers)

Just stay on them.

If your state has an Insurance Commissioner or similar regulatory oversight office, try to file an appeal through them.
It looks like there is, thanks GB.
No problem, GB. Worst comes to worst you can retain an attorney and they can even file what in California we'd call a declaratory relief action, which seeks a court finding that there is coverage and an order mandating that the insurance carrier fund the meds. Don't know that that's economical, though you might be able to get attorneys fees if you prevail.
I appreciate you letting me know about this option but you are probably correct. His doctor has been loading us up with as many sample as she can and I had one script filled. It was $270 for 30 pills with a coupon. It's normally $480 or something. I'm hoping that the generic is a fraction of the cost.
Is the generic as effective? It looks like your son just chemically works best with the stuff he's on, and while some generics perfectly mimic the original meds, others are less effective or can have side effects the other ones don't. Read up on that.

 
Just stay on them.

If your state has an Insurance Commissioner or similar regulatory oversight office, try to file an appeal through them.
It looks like there is, thanks GB.
No problem, GB. Worst comes to worst you can retain an attorney and they can even file what in California we'd call a declaratory relief action, which seeks a court finding that there is coverage and an order mandating that the insurance carrier fund the meds. Don't know that that's economical, though you might be able to get attorneys fees if you prevail.
I appreciate you letting me know about this option but you are probably correct. His doctor has been loading us up with as many sample as she can and I had one script filled. It was $270 for 30 pills with a coupon. It's normally $480 or something. I'm hoping that the generic is a fraction of the cost.
Is the generic as effective? It looks like your son just chemically works best with the stuff he's on, and while some generics perfectly mimic the original meds, others are less effective or can have side effects the other ones don't. Read up on that.
All I know right now is that it comes out some time in December.

 
Just stay on them.

If your state has an Insurance Commissioner or similar regulatory oversight office, try to file an appeal through them.
It looks like there is, thanks GB.
No problem, GB. Worst comes to worst you can retain an attorney and they can even file what in California we'd call a declaratory relief action, which seeks a court finding that there is coverage and an order mandating that the insurance carrier fund the meds. Don't know that that's economical, though you might be able to get attorneys fees if you prevail.
I appreciate you letting me know about this option but you are probably correct. His doctor has been loading us up with as many sample as she can and I had one script filled. It was $270 for 30 pills with a coupon. It's normally $480 or something. I'm hoping that the generic is a fraction of the cost.
Is the generic as effective? It looks like your son just chemically works best with the stuff he's on, and while some generics perfectly mimic the original meds, others are less effective or can have side effects the other ones don't. Read up on that.
All I know right now is that it comes out some time in December.
There will have been some published clinical trials that you can likely can likely read up on.

 
SLB, how much is the medication that works for him? #### that ####. These ####### insurance companies are all ####### crooks.
Mrs. SLB found out today that it goes generic in December. That's the good news. Bad news is he can't sleep at night and gets up early in the morning. He also goes from unhappy to jerkoff pretty much all day, every day. His memory is still all ####ed up too. He asked me 4 times in a span of 40 minutes yesterday where Mrs. SLB was. He had no recollection of asking me each time before. Neat substitute UHC.

I called the doctor's office again today to report his "progress" and the nurse said she thought with the information I gave her, she could get it covered again. We'll see.

ETA

I guess after what BB & ham have gone through, I really don't have reason to complain. :( :kicksrock:
Good news is the doctor agrees he needs to be on his old medicine and the nurse is going to try to convince the insurance company to cover it.

Bad news is he has been unbearable. In addition to what I posted above, now he's like a coke head in that he can't sit still for more than 20 seconds and he talks constantly. I have a terrible headache and I RARELY get headaches. I'm still really angry that he has had to go through this but right now, I just want my son back.
The nurse at his doctor's office called today, denied again. Why you ask? Because they don't want to pay for it, that's why.

My house has been hell for the last 8 days. It's almost non-stop yelling and screaming.

So I got some samples from the doctor so he can get on the medicine again and a script. I'll pay out of pocket. It will suck financially but I'm just conceding that there won't be any other solution. I did call UHC again however. They asked that the doctor's office send in a written appeal along with his medical records. We'll see.

I'm ####### wiped out both mentally and physically. Thanks for letting me vent message board.
Me telling Cal he's getting his medicine back yesterday. I wish Mrs. SLB would have turned down the damned TV.
I called again today because UHC decided they didn't want to talk to the nurse at the doctor's office anymore. Despite giving them, as they requested, literally, his entire medical file since birth and a letter from his doctor, they have decided to stick to their decision of denying coverage and pocketing the money. There isn't any other explanation for their decision. The cowards in the appeals department won't talk to me since "they don't have a phone number". :rolleyes:

Sorry to bring this here but I thought one of you smart people might have a suggestion. Both of the nurses I've been working with are gone this afternoon so things are up in the air until tomorrow. I'm mad right now. Really mad.

TIA
I've seen a number of very successful online petitions along these lines lately. I think yours could be one of them. I know that this board would take it viral if at all possible.

 
Just wondering what you guys' opinion is on insurance companies?
They're a necessary mother####ing cocksucking pain in my ####### evil.
You know, if you're just going to censor part of that, you may as well drop the censorship altogether.
It has been free to use for some time but I think there is a limitation or something as there are with likes.
So you're saying that if I swear enough I'll actually wear out the auto-censor function? Cool!

 
I've seen a number of very successful online petitions along these lines lately. I think yours could be one of them. I know that this board would take it viral if at all possible.
Thanks GB.
In all likelihood, your insurance contract requires you to go through a bunch of administrative hoops before you can file suit - denial levels that you have to appeal up the chain. I'd start that immediately, and contact an attorney as well. Though it sounds like they're waiting you out until the generic comes out in December.

 
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And if you'll share the name of the drug (you may have and I just missed it) I'll be happy to find every case I can find a reference to where an insurance company was forced to pay for it. There may be none, or a bunch. You never know.

 
So, most of the flavors of Blue Diamond almonds are ridiculous awesomeness in a can. Habanero BBQ should be outlawed they're so damn good. But today I discovered the Salted Caramel almonds, and after a couple dozen of them, I'm still not sure if I love them or hate them. They're so... something. I just don't know what that something is yet.

 
So is TJ as thin skinned as he's coming across in the "son got served" thread, or is this just shtick?
seems ok to me. said his piece, appreciated one of your barbs. what more should he do besides go along for the so-obvious-even-I-was-aware-it-was-a RIDE that that thread is.

 
So, most of the flavors of Blue Diamond almonds are ridiculous awesomeness in a can. Habanero BBQ should be outlawed they're so damn good. But today I discovered the Salted Caramel almonds, and after a couple dozen of them, I'm still not sure if I love them or hate them. They're so... something. I just don't know what that something is yet.
I eat just the plain, roasted un-salted... and even those are crack. whack.

 
So is TJ as thin skinned as he's coming across in the "son got served" thread, or is this just shtick?
seems ok to me. said his piece, appreciated one of your barbs. what more should he do besides go along for the so-obvious-even-I-was-aware-it-was-a RIDE that that thread is.
Yeah, if he appreciates my barbs I have to love the guy. I'm an ####### after all.
yeah... but you're OUR #######

 
So is TJ as thin skinned as he's coming across in the "son got served" thread, or is this just shtick?
seems ok to me. said his piece, appreciated one of your barbs. what more should he do besides go along for the so-obvious-even-I-was-aware-it-was-a RIDE that that thread is.
Yeah, if he appreciates my barbs I have to love the guy. I'm an ####### after all.
yeah... but you're OUR #######
:wub:

 
The cowards in the appeals department won't talk to me since "they don't have a phone number". :rolleyes:
"That's no problem, Nurse Crotchet. I don't want to inconvenience them anymore than necessary. Just give me a direct number to them, and I'll make their lives a little easier."

"I'd like to speak to a Supervisor."

"Hi! You're the supervisor? I'd like to speak to your boss."

Repeating about 2 more times ought to get you to an AVP. Officers can usually make decisions and often will when put on the spot.

 
The cowards in the appeals department won't talk to me since "they don't have a phone number". :rolleyes:
"That's no problem, Nurse Crotchet. I don't want to inconvenience them anymore than necessary. Just give me a direct number to them, and I'll make their lives a little easier."

"I'd like to speak to a Supervisor."

"Hi! You're the supervisor? I'd like to speak to your boss."

Repeating about 2 more times ought to get you to an AVP. Officers can usually make decisions and often will when put on the spot.
I tried this initially but they insisted there was nothing they could do. Guess I'll be trying again.
 
And if you'll share the name of the drug (you may have and I just missed it) I'll be happy to find every case I can find a reference to where an insurance company was forced to pay for it. There may be none, or a bunch. You never know.
Thank you so much, Intuniv.
Facebook got Humana to cover it, but I can't find any cases.

Guanfacine ER is, in fact, supposed to come out in generic on December 1, 2014, thanks to a settlement between Actavis and Shire (Shire makes Intuniv, Actavis will make the generic.) Otherwise we'd be looking at September, 2015.

I'd recommend you have a prescription in hand on that date to bring in and get the ball rolling. There's no way you'd get a lawsuit completed before then - they can wait you out. But if you keep calling and moving up the chain, and let them know you want to switch to generic when it comes out, someone high up the food chain could give you 2-3 month approval pending generic.

 
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Just stay on them.

If your state has an Insurance Commissioner or similar regulatory oversight office, try to file an appeal through them.
It looks like there is, thanks GB.
No problem, GB. Worst comes to worst you can retain an attorney and they can even file what in California we'd call a declaratory relief action, which seeks a court finding that there is coverage and an order mandating that the insurance carrier fund the meds. Don't know that that's economical, though you might be able to get attorneys fees if you prevail.
I appreciate you letting me know about this option but you are probably correct. His doctor has been loading us up with as many sample as she can and I had one script filled. It was $270 for 30 pills with a coupon. It's normally $480 or something. I'm hoping that the generic is a fraction of the cost.
Did you check out that link to the online pharmacy I sent you?

Any cheaper?

 
So is TJ as thin skinned as he's coming across in the "son got served" thread, or is this just shtick?
I don't know him, but other than the comment about whether ditch was a good father, he has made more sense than anyone else in there.

But then again, I'm the one who suggested that maybe dutch's kid took his provocation took far and should apologize.

 
And if you'll share the name of the drug (you may have and I just missed it) I'll be happy to find every case I can find a reference to where an insurance company was forced to pay for it. There may be none, or a bunch. You never know.
Thank you so much, Intuniv.
Chemical Name: Guanfacine Please select Dosage and Quantity Product Manufacturer Dosage Quantity Price($USD)
rx.gif
Tenex Sachet Brand 5 gm 20 $75.00
rx.gif
Tenex Sachet Brand 5 gm 50 $109.00
 
My youngest (Young Samuel) turned 1 today. We have 2 kids, and have discussed in passing having a 3rd. I'm really torn about it. On the one hand, I love having kids, they're a ton of fun and I'm sure I'd love a 3rd one just as much. On the other hand, I'd just be adding more years of sleep deprivation and financial strain. There are additional worries, like what if the new kid comes out disabled or deformed or some such thing.

Of course now I'm debating the existence of another human being on whether or not it's convenient for me. For whatever reason I feel petty saying an extra few hours of sleep and some extra cash as a priority. But God-Damn do I love to sleep.

Another kid also would increase the odds that someone will love me when I'm old.

 

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