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Question:

I am 41 years old, was diagnosed with type 1 diabetes about a year ago and is in good control, and I have a severe nail fungus. My physician prescribed a medication called [name deleted] last week, and now I'm having a terrible time gettting my insurance company to approve it.

The doctor and I are worried about infection. The insurance company said they would pay for an infection prescription, or if I got gangrene, but will have to wait at least 30 days to allow them to review coverage.

I'm angry and very upset. Could you put me in touch with anyone who can help me fight this? What are my rights as a person with diabetes, especially when my doctor states this is necessary?

Answer:

I'm afraid this is a consistent response by the insurance companies for this problem.

JTL

[Editor's comment: Add another frustrated patient (and apparently a frustrated physician also) to the list. If the doctor continues to spend uncompensated time fighting for your medication, you may eventually get it. (I usually figure that the insurance industry pitches the first request into the wastebasket, reads the second, but also throws it, laughs at the third before rejecting the request, and about the fourth time, you may get lucky and get someone in a good mood to approve it. At least in your case they are "reviewing" the request.)

You will need to have your physician write a "letter of medical necessity" and probably should keep a copy to send to the insurance commissioner in your state if you continue to get rejections. In the meantime, pay for the medication out of your own pocket, and keep the receipt. WWQ]

DTQ-ONCEMWWQ20010424
Original posting 7 May 2001
Posted to Insurance/Costs

  
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Last Updated: Tuesday April 06, 2010 15:09:22
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