So complicated

Discussion in 'General Parenting' started by vchaffin, Jul 29, 2011.

  1. vchaffin

    vchaffin New Member

    so when the psyciatrist prescribes my 3 yr old foloicine XR and the insurance refuses to pay for it and asks for a prior authorization and takes 3 weeks to deny paying for it at all the dr says its because of her age they don't want to pay for it. ok so he changes the medications, well he writes myself the same rx for myself and they ask for prior autorization. I don't understand, we pay out the butt for insurance but its like pulling a tooth to get them to pay anything...They will pay for bipolar medications but not adhd?? doesn't make since to me
  2. keista

    keista New Member

    It's a relatively new drug and no generic is currently available. This isn't about your child's age, but about money. Insurance companies only pay for the name brand stuff if you've tried EVERYTHING else and the Dr argues your case that the other medications did not work well (or had side effects) and that this is the medication that's needed. Your psychiatrist needs to pull from the generic 'bag of tricks'

    General information about focalin XR and availability of a generic

    focalin XR website for coupons if you want to try it and self pay. And there might be somewhere on the site to get even more assistance in paying for it if you qualify (most companies have that these days)

    The problem with some of the newer drugs is that there isn't very much practical information available - side effects, long term effects, etc. Especially for a 3 y/o I'd start with one of the older standard medications.
  3. HaoZi

    HaoZi Guest

    Seems everything requires a PA these days. Some insurances won't cover something not because of what it is but because of how it's dosed. It might not be a bad idea to call the company and find out so the doctor can write it out and PA it in a way they'll pay it.
  4. vchaffin

    vchaffin New Member

    on my 3 yr old it was the 3rd medication they tried..Then they tried regular foloicine...But they asked for PA for me too..Ive got a 60.00 off card but thats still 200 out of pocket i have to pay for a medication that i don't even know if it will work..Im on lamictal right now but he thinks i have more ADHD than BiPolar (BP) so he was gonna try adhd medications. Go figure it all gives me a headache lol
  5. JJJ

    JJJ Active Member

    A 3 year old on her third stimulant????

    It sounds like you and your daughter are seeing the same psychiatrist. Please, please get her to a specialist who focuses on the early childhood ages.

    What type of testing has been done on your daughter? Have you contacted your local school system yet? What behaviors does she exhibit that caused the need for medications?
  6. HaoZi

    HaoZi Guest

    You can also contact the company that makes the medication and ask if they have anything for a trial period or to help with cost. A lot of them do, some will even call the pharmacy with the code for you to get a 10-14 supply for free.
    I'd also go with 3J's idea and find a better fitting psychiatrist for her, something else is up and this doctor isn't seeing it.