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formulary issue
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<blockquote data-quote="ysne58" data-source="post: 104531" data-attributes="member: 3570"><p>Yeah I am going to be following the process with an individual exemption.</p><p></p><p>I think the real reason they addressed this to my son instead of my husband is because they were hoping I would think it was junk mail and throw it away without reading it.</p><p></p><p>There were several medications on the list and only one of them is prescribed for my son. If only the medication he is taking had been listed I might believe this was a mistake.</p><p></p><p>The fact is, I'm tired of having to do this with myself or a family member ever other month or so. This company keeps doing something it shouldn't be with notice issues, and while i'm trying to get the bozo's at the state employee relations department to do something about that they move on to something else.</p><p></p><p>Last July my doctor appealed the denial of a medicine I need to keep taking. They called my doctor's office and said they were denying the appeal and were not going to issue any kind of written decision. I called them and told them they were going to issue a written decision and at the same time emailed the bozos at the state employee relations department.</p><p></p><p>November 20 comes along and I still don't have this document so I contact the company and the employee relations department. A week later I get a call from this insurance company, they did deny this appeal in July and did file it and chose not to sene me anything in writing. They also said that they were sending out a new denial that I could appeal. I contacted the the company and employee relations people and demanded the name and contact information of the agency that regulates this company.</p><p></p><p>The next day the insurance company emailed me the name of the agency and a telephone number that was three years or more out of date. The employee relations department didn't bother replying for another week and instead of providing the information I had demanded, they sent me an appeal form.</p><p></p><p>I still don't have a copy of the documents that denied the appeal my doctor filed for me in July. The state legislature and two unions are also inquiring into this cute little attempt to deny due process. I have taken steps to make sure this stunt will never be used again.</p><p></p><p>But in the meantime I finally have an appeal form from the idiots at the employee relations department. (The fact that there are unresolved issues going back to 2005 that they never bothered to send me appeal forms for probably means this issues are still open.) I have demanded this information repeatedly and still don't have it. I've got an appointment with an attorney on Monday. If this goes to court just because I have to ask a judge to tell the insurance company to give me a document so I can file an appeal... well this is way beyond rediculous.</p><p></p><p>And now I have yet another go round to do on medications on top of this? I think I may just have an opportunity to use this cute little due process stunt to make them change how they make these formulary decisions. If I succeed I will be making life easier for me, and for others too. I'm really sick of this though.</p><p></p><p>Cathy/Ysne</p></blockquote><p></p>
[QUOTE="ysne58, post: 104531, member: 3570"] Yeah I am going to be following the process with an individual exemption. I think the real reason they addressed this to my son instead of my husband is because they were hoping I would think it was junk mail and throw it away without reading it. There were several medications on the list and only one of them is prescribed for my son. If only the medication he is taking had been listed I might believe this was a mistake. The fact is, I'm tired of having to do this with myself or a family member ever other month or so. This company keeps doing something it shouldn't be with notice issues, and while i'm trying to get the bozo's at the state employee relations department to do something about that they move on to something else. Last July my doctor appealed the denial of a medicine I need to keep taking. They called my doctor's office and said they were denying the appeal and were not going to issue any kind of written decision. I called them and told them they were going to issue a written decision and at the same time emailed the bozos at the state employee relations department. November 20 comes along and I still don't have this document so I contact the company and the employee relations department. A week later I get a call from this insurance company, they did deny this appeal in July and did file it and chose not to sene me anything in writing. They also said that they were sending out a new denial that I could appeal. I contacted the the company and employee relations people and demanded the name and contact information of the agency that regulates this company. The next day the insurance company emailed me the name of the agency and a telephone number that was three years or more out of date. The employee relations department didn't bother replying for another week and instead of providing the information I had demanded, they sent me an appeal form. I still don't have a copy of the documents that denied the appeal my doctor filed for me in July. The state legislature and two unions are also inquiring into this cute little attempt to deny due process. I have taken steps to make sure this stunt will never be used again. But in the meantime I finally have an appeal form from the idiots at the employee relations department. (The fact that there are unresolved issues going back to 2005 that they never bothered to send me appeal forms for probably means this issues are still open.) I have demanded this information repeatedly and still don't have it. I've got an appointment with an attorney on Monday. If this goes to court just because I have to ask a judge to tell the insurance company to give me a document so I can file an appeal... well this is way beyond rediculous. And now I have yet another go round to do on medications on top of this? I think I may just have an opportunity to use this cute little due process stunt to make them change how they make these formulary decisions. If I succeed I will be making life easier for me, and for others too. I'm really sick of this though. Cathy/Ysne [/QUOTE]
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