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dreamingneonblack

Dealing with US Health Insurance Coverage

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dreamingneonblack

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
Added admin note

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manymoretodays

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.

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dreamingneonblack

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

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LexAnger

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.

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Altostrata

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.

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BuddhaMama

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!

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Stormstrong

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.)

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SkyBlue

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.

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Altostrata

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

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arwilliams

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.

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Altostrata

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.

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