View Full Version : stupid health insurance...

07-16-2003, 12:26 PM
Julia has eczema, and she was finally able to see a pediatric allergist yesterday. We had bloodwork done to determine what she is allergic to, and I hope to get the results next week.

In the meantime, the dr prescribed an oral antihistamine and Elidel cream. I went to pick up her prescriptions today, and the pharmacist informed me that my health insurance company would not authorize the Elidel - probably to save money. They suggested a prescription strength cortizone instead. Hello! That's a steroid - repeated usage can be dangerous b/c it thins out the skin. We do not want this! And it's not like we have some backwoods insurance company - it's Blue Cross Blue Shield, for crying out loud!

I can't believe my insurance company would do this. My husband is furious. I'm still trying to get a call back from the dr's office, but I am so angry right now. I just want my poor baby to feel some relief soon. This had better get resolved, and fast...

Mama to Julia 1-10-02

07-16-2003, 12:52 PM
That IS outrageous. It doesn't even sound like they're trying to push a generic on you, but a totally different product!! x(

07-16-2003, 01:20 PM
I HATE when insurance companies blindly try to second-guess the doctors. But your doctor should be able to write a note (waste of his time, since he shouldn't have to do it...) and get the prescription covered.

07-16-2003, 01:51 PM
Also, try calling the insurance company directly. Sometimes the refusal process is done automatically and a human can override it. Anyway, make sure to write down names. I have gotten three different answers from calling my insurance company about the same question. I just kept calling until I got an answer that was remotely sensible and then followed up with a letter saying, "this letter is to confirm the conversation I had with X on DATE in regards to...if my understanding of your coverage is incorrect, please inform me in writing immediately." Then mailed it, faxed it, and kept copies of everything.

GOOD LUCK. May you get a non-moron on your first go-round!

07-16-2003, 02:36 PM

Email me at [email protected]

I might be able to help you.

07-16-2003, 02:58 PM

Email me. I think I can help you too.

07-16-2003, 04:00 PM
Colleen -

Elidel currently has no generic equivalent and should be covered by most insurance. If you still encounter resistance from Blue Cross Blue Shield(we have it too, but no problems with Rx coverage) ask your allergist what they think of Protopic or Elocon. Also, if you do get the Elidel approved, make sure your Rx is written for 100g tube as the 30g tube is much smaller and you don't want to skimp on Julia's applications. As for the cortizone, we try to avoid it, but when Katie's hands get cracked and peely, we do have to do some supplementing to her Elidel and Zyrtec. HTH! PLMK if you need anymore info on the meds.

mom 2 Katie (31 months)
& Jack (15 months)

07-16-2003, 10:15 PM
sorry to hear about the health insurance...we also have blue cross blue shield and Im about to get into it with them over not covering some of my prenatal testing...ugg!~
I hope that you are able to resolve the medication thing...in the mean time I dont know if you have tried it but oatmeal baths do help! especially if she likes to play in the water. I have ezcema myself so I know how miserable it is.
While waiting for the perscription to go through I think you should try the cortizone cream, while it does thin the skin,. thats only after repeated use in the same area and it should only take a day or so for it to work and not cause the thinning, the thinning only occurs if you have it on over weeks of use. Usually it will work overnight for me so in the mean time it might be worth trying on those really bad patches of skin just for some relief for her. Once the "blisters" are gone the itching stops and its just a matter of keeping the skin from breaking out, which the cream should do so you shouldnt need the cortizone that much. Dont know what to tell you other then keep her cool, in loose 100% cotton clothes and hope for the meds to go through...good luck!

07-17-2003, 10:44 AM
We went through something similar to this with BCBS too. What we did was file and appeal and our doctor had to send a letter stating why the medication he prescribed was necessary and why there wasn't a "better" medication that was on their "approved" list.
My DH went round and round with them, and finally, they approved it and paid us back for what we had paid out of pocket.
My advice is to call your insurance company, ask why they don't cover it and find out what you need to do to appeal the decision.
good luck, insurance companys are a HUGE PITA!!!

07-17-2003, 12:29 PM
Elidel wasn't out when my daughter's eczema was diagnosed so we got Aclovate a steroid cream, yeah over time if used more than 2 times a day every day it can cause problems but when she had horrible cracking on her legs due to a reaction to something it was the only thing that worked. We only use it on her when she is really bad and try not to use it for more than 2-3 days in a row. The rest of the time we just try and keep it from breaking out too bad by using a good lotion at least once a day and giving her quick baths in warm water with johnsons moisturizing bath. From there we just avoid scented things and stuff that might break her out.

But I see your point, the insurance should have covered what the doc prescribed, it stinks when they try and play doctor! I hope you get it covered.

07-17-2003, 12:37 PM
Thanks to all of you for your advice and encouragement. You've all been so nice and helpful! I'm so sorry for those of you who have had to deal with this and not been able to get an acceptable resolution.

Looks like it won't be a problem after all. The doctor's office has faxed a "Physician Request for Prior Authorization" form to Blue Cross. I'm told it should go through with no problem, as the doctor is a specialist. (The nurse said they've never been refused.) The downside is that it may take up to a week for the paperwork to go through. The upside is that it will be approved through the year 2099, so we won't have to worry about it with every refill. We can wait a few days so long as we know that it is coming!

Thanks again. You've made me feel so much better.

Mama to Julia 1-10-02

07-17-2003, 01:00 PM
Glad it is going to work out for you Colleen. I have BCBS and recently filled a script for Elidel with no problem. Go figure. But, when Hayden was three months old and had RSV, she could not tolerate albuterol. She was presecribed Xopenix in the hospital and did fine with that (the albuterol raised her heart rate to dangerous levels.) She gets discharged and I go to the pharmacy (keeping in mind that Grayson was still in the hospital at the moment so I was stretched thin to say the least) and BCBS denys the medicine. Took a week to get it (this was life-threatening and I was ticked to say the least.) Thank God for my ped. - the office gave me enough samples to hold me over until the "approval" came through.

Makes you want to go postal on someone, doesn't it???

07-26-2003, 12:10 AM
We have BC/BS too and have recently had MAJOR prescription problems! They have a website where you can see the different "tiers" of drugs and they have started charging different co-pays. They would't cover my pre-natal vitimans for goodness sake. The pharmacy at Wal-Mart didn't carry the generic vitamin for the brand my doctor prescribed. The silly vitamins were going to cost me over $45 a month because they would only consider a month's worth 1 prescription. I would have to go back every month. I was so mad - told them to keep them and bought the over the counter wal-mart brand. I don't understand why insurance companies think they know better what medication you need than your doctor.