Insurance Company Advice dealing with ADD medications

[perlguy]

Well, I finally get health insurance again because I got a new job. The health insurance even lists Concerta on its drug formulary.

So, I go to get it filled and find out that they only authorize "one dose per day".

Well, my neurologist and I worked on the dosages and what worked best for me is 2 36/mg capsules in the morning, and 1 36/mg capsule after lunch.

Yes, that is a lot from what I have heard, but that is what works for me.

I am really ****ed off at these people. There is a legal "rider" on our prescription policy that states we can get up to 100 capsules of covered medication per month. Then there is some other paper, which does not appear to be a legal document, just a list. It is of medications that are only allowed to have 1 dose per day.

I am working on an appeal, but this is just crap! If I had high blood-pressure, or AIDS or something else, and I had to take "more than one dose per day" to stay alive - would they let me?

Grr, I am just venting right now. I can't afford this medication, but without it I doubt I'll be able to keep up the expected performance at my job.

Anyway, tips, suggestions, anything that could help would be appreciated. The insurance company is GHP, when I told my Dr.'s office that I was told that "they are the worst". I am seeing that clearly now.

Brent

[BobbyK]

I understand how you feel I have been down the same road in the past I now do not have any health insurance but that is by my own choice. I think that health insurance is nothing but a joke if you never make a claim they like you but if you need something they never want to give it to you.

[NightStar]

I am in worse situation here, I am a single employee and so far insurance offered to me, would not cover mental illness at all, plus a whole host of other things which were important to me.

I have read about Medical IRA accounts that sounded really good for back up. They allow you to put in so much per year. Plus what you don't use gets rolled over to the next year interest free account. But it is secondary to a primary insurance. But you can use it for what ever purpose you want, no one telling you you can't get this or that.

[BobbyK]

I have never heard of them NightStar thanks I am going to look into that for myself

[NightStar]

http://www.rlevansco.com/faq_s__msa_general_.html

Here this looks like an interesting site explaining better then me on these MSA IRA Accounts.

[perlguy]

Hmm, all of the MSAs that I have been offered through my employers so far have seemed good. Up until the point where they tell me that any money left over at the end of the year is lost!

The one you mentioned rolls-over your unused money. THAT is something I would consider. However, if I can only get into a plan that basically *takes* my money if I don't use it, I will hang on to it myself. I realize that I could save money from taxes etc, but I have a hard enough time keeping track of everything else, I would not want to worry about this also.

Are there any MSAs offered based on the fact that we (ADDers) are covered under the ADA?

Thanks!

Brent

[BobbyK]

Thanks NightStar

[NightStar]

I can't find the original article which caught my attention on this, but with the MSA I do believe that you can use it for anything! That no one can tell you otherwise since it is your own saved up money to back primary insurance.

I am in a fix myself, have to find a 1st primary plan (so far I have not looked much) but didn't see any that covers mental illness, so when my employer offered on, I passed on it, since that is what I needed most, was cost of meds and such for ADD.

Plus the plan he picked didn't even cover dentures for dental plan, I just have not found anything covering what I need,

I did recently start a IRA account through work for pension plan, but I only put $50 per month in it, and it can be transferred to other jobs I might work if I leave here, it is automatically taken out of my pay.

[BobbyK]

I need to get something setup for me and my son to make sure if something happens to me he is taken care of and to make sure I will be taken care of when I want to stop working if that ever happens LOL

[NightStar]

For being ADD and jumping jobs a lot that was the best thing my employer could have done getting me set up with the IRA account, I am so worried about retirement myself, having enough money to get by.

I just wish there was like unemployment insurance for ADDers - know for that between job time, on not falling behind on finances and such till new work is picked up.

I know credit card companies have credit protection plans, but that is most part a rip off, good luck cashing in on it if you do need it is what I have heard.

The medical is going to be a challenge, maybe if we split off different directions and post back here what we each find, we can research further to find the best plan.. know more then one is best at this kind of stuff.

[NightStar]

*Purlguy - I am a big Iron Maden fan! Love Stranger in a strange land, and Son of the seventh son! :-)

[perlguy]

Yeah, I still love them. I've been listening to them ever since I saw them open for Judas Priest in 1983!!!

I'll have to find, or take, a good photo of my tattoo. I get a LOT of comments on it because it has the union jack on it. People always ask "why do you have a British flag on your arm"... I am like, DUH, they are a British group! ... I usually have to answer the follow-on question of "who is a British group?"

I met the band 2 years ago when they came through St. Louis. They are all really nice. I was VERY suprised though to learn that Bruce Dickinson is extremely ignorant about computers and the internet.

Talk to you later.

Brent

[Wheezie]

i wonder if you could get around it by having your doctor change your perscription.

you could "officially" be prescribed 3 36/mg capsules in the morning. that, technically, would be "one dose per day." how would they know if you didn't take it as prescribed??? if your dac is sympathetic, she/he'd probably go along with it.

unless i've misunderstood and they will only allow 1 36/mg capsule per day?

[perlguy]

yeah, they only allow for one "dose" per day.

what i've done so far, I had the doc write a new script for a "30-day" supply of the 54mg capsules. This should at least last until I've figured out something with the insurance company.

my options now are:

1) write a letter requesting re-consideration to the insurance company.

2) have my doc speak in-person to the insurance company doctor and explain why i need that particular dosage.

3) have my doc work with me to find another medication that works good for me and my insurance company "blesses"

4) [censored] -- I started typing an option here, but then figured this is one of those times I need to "hold my tongue". It was nothing bad, just potentially slanderous and I don't wish to go down that route...

Options 2 and 3 just cause MORE work for my doctor, who I am sure has better things to do than to fight with insurance companies all the time.

Brent

[NightStar]

Ok, now I am green with envy! Judus Priest!! Favorite of all time - like the Screaming for Vengence the best. Thanks for memories,


Ok, I will start looking at various insurances myself soon - see what can be found out there.. I just hate trying to read through all the red tape to understand how this business works!