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<blockquote data-quote="susiestar" data-source="post: 711984" data-attributes="member: 1233"><p>There are ways to go and prove that they have trialed those medications, have failed on them due to side effects/lack of effects, and then insurance pretty much MUST pay for the medications. It is a process of you and your doctor challenging them over and over, but it can be worth it. My sis in law is an insurance agent who sells health insurance and actually reads the policies and now helps regulate our state health insurance boards and she says you often can win if you jump through the hoops and don't give up. You have to read the fine print. It is often on the back of the EOB or the claim form or rejection notice. </p><p></p><p>There was a Grisham novel about an insurance co who just denied everything because it was cheaper to do that because many people won't resubmit or challenge to see if it was a correct denial. What MOST people don't know is that this happens way more often than people want to admit. I don't know that it is a policy with any ins company, but I have known a LOT of people who worked in claims processing for health ins companies. Every single one of them quietly told me to challenge every single denial even if I thought it was proper. They stressed to challenge every single denial no matter what. </p><p></p><p>I have done this. I have succeeded MANY times when I thought it was hopeless. Sometimes when I should have succeeded, I didn't. But I have always felt it was worthwhile to NEVER accept the first no, and often to not accept the second one. </p><p></p><p>Find out what the procedure is for resubmitting a claim, and for challenging a denial. Then get good at paperwork. Make cookies or send flowers or whatever for the nurses at your doctor's office, so they like you and will help. Keep them on your side. Trust me, it always helps. So few patients show true appreciation and even the smallest gesture can get those who know the paperwork to truly help you. My neurologist just told me the real difference between getting my migraine treatment approved is not what they write in my chart, it is what code they put down in what order. So being nice to the person who learned what order makes the company happy this week? Is well worth my time.</p></blockquote><p></p>
[QUOTE="susiestar, post: 711984, member: 1233"] There are ways to go and prove that they have trialed those medications, have failed on them due to side effects/lack of effects, and then insurance pretty much MUST pay for the medications. It is a process of you and your doctor challenging them over and over, but it can be worth it. My sis in law is an insurance agent who sells health insurance and actually reads the policies and now helps regulate our state health insurance boards and she says you often can win if you jump through the hoops and don't give up. You have to read the fine print. It is often on the back of the EOB or the claim form or rejection notice. There was a Grisham novel about an insurance co who just denied everything because it was cheaper to do that because many people won't resubmit or challenge to see if it was a correct denial. What MOST people don't know is that this happens way more often than people want to admit. I don't know that it is a policy with any ins company, but I have known a LOT of people who worked in claims processing for health ins companies. Every single one of them quietly told me to challenge every single denial even if I thought it was proper. They stressed to challenge every single denial no matter what. I have done this. I have succeeded MANY times when I thought it was hopeless. Sometimes when I should have succeeded, I didn't. But I have always felt it was worthwhile to NEVER accept the first no, and often to not accept the second one. Find out what the procedure is for resubmitting a claim, and for challenging a denial. Then get good at paperwork. Make cookies or send flowers or whatever for the nurses at your doctor's office, so they like you and will help. Keep them on your side. Trust me, it always helps. So few patients show true appreciation and even the smallest gesture can get those who know the paperwork to truly help you. My neurologist just told me the real difference between getting my migraine treatment approved is not what they write in my chart, it is what code they put down in what order. So being nice to the person who learned what order makes the company happy this week? Is well worth my time. [/QUOTE]
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