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Dealing with US Health Insurance Coverage


dreamingneonblack
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ADMIN NOTE Also see Low-cost drugs: Getting your prescription filled on a budget

 


 

I'm just curious if anybody has ever attempted to contest an insurance company for not covering the liquid or brand name form of their  ssri? I'm considering attempting but I don't know that it will be worth my efforts, even in terms of savings. Even if I decide to stay on liquid paxil without insurance, it will be costing me around $1500 a year 😕 I'm really just trying to avoid the impending withdrawals of switching back to generic tablets and also having to make sure they don't switch manufacturers on me.

Edited by Altostrata
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2011 on paxil 10mg

2013 switched to oral suspension, 10mg

No documentation of tapers in this time period

2015 tapered down to 4.8 mg

2016 after enduring extreme depression for 6 months, psychiatrist suggested returning to previous dose. Back up to 5.2 mg

2017 4.8 mg  

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Yah......I had good luck once getting the same stuff I wanted........not on my own though.......the prescribing Dr. had to go to bat for me and fill out paperwork and of course there was a wait..........  I think that it's possible that alot of Dr's do understand that the different versions of the same medication can have different effects on us.  Good luck.  My experience was years ago.......I wanted to stay on Lexapro rather than switch to Celexa and it happened.  So......not exactly the same......similar though.

 

I'd suggest calling the insurance company and finding out what hoops you have to jump.  And being patient with the process.  And having a Dr. on board.

2022 May- continuing with limited activity on site, just something I need to do right now

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016.  And.....I quit smoking 11/2021.  Can you say Hallelujah?(took me long enough)💜

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

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Thank you many! It gives me hope to hear that. The first hurdle that I will attempt tomorrow is just getting my dr to agree to this. Keep your fingers crossed for me

2011 on paxil 10mg

2013 switched to oral suspension, 10mg

No documentation of tapers in this time period

2015 tapered down to 4.8 mg

2016 after enduring extreme depression for 6 months, psychiatrist suggested returning to previous dose. Back up to 5.2 mg

2017 4.8 mg  

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I was switched from brand to generic by insurance without my knowing apor my dr knowing, I called the insurance directly telling them I got severe reaction to the generic and got very sick from it. They did right away.

 

As for liquid, you can also tell them you tried making liquid yourself but got serious problems as it doesn't provide accurate MG.

 

Insurance definitely would try not involve in any legal situations so they tend not to ignore such requests.

Drug free Sep. 23 2017

2009 Mar.: lexapro 10mg for headache for 2 weeks.

2009-2012: on and off 1/4 to 1/3 of 10mg

2012 June--2013 Jan,: 1/4-1/3 of 10mg generic, bad jaw pain

2013 Jan-Mar: 10 mg generic. severe jaw and head pain;

2013 Mar--Aug. started tapering (liquid ever since) from 10 to 5 (one step) then gradually down to 2.25 mg by July. first ever panic attack, severe head/jaw pain

2013 Aug.: back to 2.75 mg; Nov: back to Brand Lex. 2.75mg -- 3mg,

2014 June: stopped PPI, head pressure/numbness. up-dosed 4.5mg, severe reaction mental symptoms added on

2014 Aug--2015 Aug: Micro taper down to 3.2mg, .025mg (<1%) cut holding 2-3 weeks.

2015 Aug 15th, Accidental one dose of 4.2mg. worsening brain non-functional, swollen head, body, coma like, DR

2016 Feb., started dosing 10am through 11 pm everyday 2/13--3.2mg, 3/15-- 2.9mg, 4/19-- 2.6mg, 6/26--2.2mg, 7/22 --1.9mg, 8/16--1.8mg,8/31--1.7m g, 9/13--1.6mg, 9/27--1.5mg, 10/8--1.4mg, 10/14--1.3mg, 11/1--1.2mg, 11/29--1.1mg, 12/12--1mg, 12/22--0.9mg

2017: 1/7--0.8mg, 1/15--0.7mg, 1/17--0.6mg, 1/20--0.52, 1/21--0.4mg, 1/22--0.26, 1/23--0.2, 2/13--0.13mg, 2/20--0.06mg, 3/18--0.13mg, 6/1--0.12mg, 7/6--0.1mg, 7/14--0.08mg, 8/17--0.04mg, 8/20--0.03mg, 8/28--0.02mg, 9/6--0.0205mg, 9/8--0.02mg, 9/17--0.015mg, 9/20--0.01mg, 9/21--0.0048mg, 9/22--0.0001mg,

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The prescribing doctor has to make an argument that 1) a substitute drug would have an undesirable effect; or 2) a dosage is required that cannot be fulfilled with available tablet sizes; or 3) both.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I asked my doctor to file a Treatment Authorization Request for the liquid and miraculously, my insurance company covered it. Probably because the compounding pharmacy is using generic tablets to make the liquid, but I'm still shocked. Good luck!

OFF Paxil 1996-1997 CT, no w/d sxs

OFF Celexa 2002 (6 months) CT, mild and brief w/d sxs

OFF Ativan 1mg-Cold Turkey 2014, WD Syndrome for several weeks despite intermittent use over 9 months rather than daily use.

OFF Lexapro 3 doses only February 2015 (increased depression)

OFF Paxil 3 doses only July 2016 (increased anxiety)

ON Remeron 15mg daily since AUG 2016 for PPD/PPA/PPOCD Tried cutting dose by 1/4 tablet  December 1, 2016, one week of intense withdrawal headaches, reinstated 15mg dose December 8, 2016.

ON bioidentical Progesterone cream 50mg/day originally started for self diagnosed estrogen dominance April 2015, continued use during pregnancy to alleviate hormonal headaches October 2015-July 2016, continued postpartum to help with mood July 2016-present.

Supplements: Magnesium, Fish Oil, Probiotics, Quercetin

Tried Methylfolate Sept 2016 to "potentiate" Remeron - ended up experiencing worsened side effects (mainly irritability bordering on rage) Discontinued after two doses.

BEGAN REMERON TAPER Feb 2 2017 by switching to different manufacturer of tablet mirtazipine (manufacturer that matches my liquid solution). Holding 15mg dose until adjusted. Plan to eventually do half liquid, half tablet (still 15mg), then all liquid (15mg), then .95ml of 15mg per ml liquid (a 5% reduction) depending on how I respond to adjusting from tablet to liquid.

August 2017 9mg liquid mirtazipine, cutting by 2% every week.

July 2018 3mg liquid Mirtazipine,cutting by 2-3% every week.

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  • 8 months later...

The list of recommended psychiatrists and doctors in this forum is a terrific resource, but none of them take Medicaid, which over here in the US, is insurance for those who live below the poverty line. Absolutely can't afford to pay out of pocket. I'm stuck with psychiatrists I randomly pick from the Medicaid book, or random ones that work close to where I live. 

 

If others are in the same situation, what are some good strategies you have found, that can aid in tolerating the "bad" psychiatrist as much as possible?

 

I understand that the best strategy is never to get him or her involved in your withdrawal and keep these things to yourself. What if you have already revealed the truth to them, and it's too late to cover up? 

 

(I'm seeing a new psychiatrist and I have to grit my teeth to prevent myself from getting very angry and defensive... . I wanted to scream when he asked me, incredulously, "What do you mean by "intuition"?" It's greatly adding to the stress.)

2000: Paxil, low dose. 2001: Paxil, quickly tapered off. 2006: Zoloft, 25mg. 2007: Wellbutrin, low dose, discontinued after a week or a month. 2007-2009: Zoloft, increasing dose (up to 75mg). 2009-2011: Zoloft, failed withdrawal attempts (cold-turkey; fast tapering). 2009-2011: Trying out Cymbalta, Celexa, Prozac, Lexapro, Ambien, Ativan, and Xanax. 2012-2015: Zoloft, 100mg to 200mg. 2013: Trazadone for Zoloft-induced insomnia, 25mg to 50mg.  2015: Trileptal, dose?, withdrew; Bupropion, up to 200mg. 2016: Zoloft, 137mg, Bupropion, 150mg, Trazodone, 25mg.

05/21/16: Began Zoloft taper - 10% from 150mg - 137ish mg

06/23/16: Zoloft taper - 125mg

08/03/16: Bupropion XL taper - cut 150mg pill in crude half (mistake)

10/31: Zoloft successfully down to 100mg. Staying on 100mg for 2-3 months to let my brain rest.

11/09: Wellbutrin SR prescribed, 150mg once a day, for withdrawal.

12/11: Wellbutrin SR, twice daily - minus 18ishmg = 112.50mg

09/30/17: Off Wellbutrin SR successfully. Zoloft taper: 90ish mg (shaving it off). Trazodone: still at 50mg.

June 2018: Zoloft: 80ish (shaving off). Trazodone: 6mg. End of 2018: Off Trazodone.

01/20: Zoloft: 70ish?

08/20: Still around 80 or 70. Tapering by only 15 shaves each month.

04/2021: 50mg!

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  • 2 months later...
  • Moderator Emeritus

Hi Storm,

 

I have the same question: it's great that there are all these supportive doctors, but really unfortunate that basically none of them take insurance. 

 

On 10/26/2017 at 2:37 PM, Stormstrong said:

If others are in the same situation, what are some good strategies you have found, that can aid in tolerating the "bad" psychiatrist as much as possible?

 

I understand that the best strategy is never to get him or her involved in your withdrawal and keep these things to yourself. What if you have already revealed the truth to them, and it's too late to cover up? 

 

I could have written this myself, "what if you have already told them about the taper and now they're trying to mess with it?"

 

What I have done, working 100% within insurance so far, is to basically work with one prescriber until I hit a wall or they leave; then starting over with another prescriber. 
I'm running out of health systems, though, because all clinics in one health system of course share info. So it's not possible to go in and say, hey, yeah, I'm on a regular dose of my meds, can you just refill it? 

 

So I'm chiming in more for solidarity than with actual answers, but it's an extremely important problem.

 

And we as a community need to keep adding to and updating that list when we find taper-friendly providers that accept insurance.

 

2020: After 18+ years (entire adult life) on Paxil, a dangerous doctor-led "taper" in 2015, and four years tapering off the last 1 mg thanks to SA and the Brassmonkey slide, 

I AM COMPLETELY FREE OF PAXIL! ! ! ! ! ! ! ! Forever.

 

2021: Began conservative, proper, CNS-respecting taper of Zoloft, led by the only expert on me -- me. Making own liquid. 5-10% plus holds.

2022: Holding on Zoloft for now. Current dose 47 mg. Hanging in, hanging on. Severe protracted PAWS, windows and waves. While I may not be doing "a lot" by outside standards, things are graaaaadually getting better

 

Yoga (gentle to medium); walks; daily breath practice; nutrition, fruits/veg; nature; water; EastEnders (lol); practicing self-compassion, self-care; boundaries; connection; allowing feelings; t r u s t ing that I, too, will heal. (--> may need to be reminded of this.)

"You are not alone, and this is not the end of your story." - Baylissa

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  • Altostrata changed the title to Dealing with US Health Insurance Coverage
  • Administrator

Please note that any doctor can prescribe psychiatric drugs, it doesn't have to be a psychiatrist. The best doctor to work with is one with whom you can communicate. As SkyBlue implied, you may have to kiss a few frogs before finding the right doctor for your tapering project.

 

Even if a doctor is sympathetic, it's unlikely he or she will know anything about tapering. You will have to present your own plan, calmly and reasonably. It may help to describe it as minimizing your drugs, rather than going off completely, as many doctors are fearful of the dreaded "relapse." See

 

How to talk to a doctor about tapering and withdrawal
 
What should I expect from my doctor about withdrawal symptoms?

Edited by getofflex
repair broken link (first link)

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Although you may be right alto in my experience my primary care physician refused to touch psychiatry.  This also changes at academic medical centers. For example I won't name which but at my academic medical center they only see psych patients in patient and primary care doctors refuse to prescribe anything.

My Intro FB Zyprexa 2015-September 2018

1st time I tried to come straight off of 10mg Zyprexa I was hospitalized for insane insomnia.

Current - Abilify Maintena & L Theanine(for akathisia)

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That is the choice of your primary care physician and the local policy of those medical centers. There are plenty of doctors of all types who prescribe psychiatric drugs.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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