Need Advice on What to Do!

[cameorose]

Okay here's the problem. My husband carries the health insurance at work. He lost his job back last fall. Well he found one in January. He got the insurance. But it penalized me for being a diabetic. It stated carring me May 6. Well all this time I have been on Januvia, the doctor gave me sample's once a month, to help me out till I got covered. Well now that I am covered they have denied me 3 time's in a row. They refuse to pay for my medicene. They said my a1c level is 6. So I don't need the medicene. The Doctor explained that I was already on Januvia and that was the reason it was good. They still refused. Since when did insurance company's become doctor's. This could literally be life and death for me.
Does anyone know of a course of action for me? I have called and this last time they told me not to reapply again. It was a waist of my time and their's. Can you even imagine that!! I am worried. Thank's Cameorose

[disneysteve]

First, your doctor needs to know exactly what their criteria are for approving Januvia. If you meet the criteria, then he needs to call and speak to their medical director and appeal your denial doctor to doctor.

Just this morning, I filed an appeal for a patient for Januvia. Her insurance company required that she had to have failed Metformin and failed a TZD or sulfonylurea drug. In fact, she is on Metformin and did fail both a TZD and sulfonylurea, so she meets every criteria to get Januvia. If they deny my appeal, I will call and speak with the medical director.

[cameorose]

Thank's

Thank's for the info! I am going by my doctor's tommorrow with what thing's I have found out. Wish me Luck! CameoRose