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Patients Suffer When Insurance Companies Deny Medication Coverage

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A while back I found a treatment for my migraines that actually worked. Unfortunately, my insurance denied it stating it was “experimental.” I asked my doctor about it and he stated that it has been around for over 15 years, and he’s had excellent results with his patients. I tried to appeal, but they stood by their decision. Needless to say, I still struggle with debilitating migraine pain since I can’t take triptans or anything that contains it.

Another instance of being denied coverage is when I had my “preventative care” flu shot. I went to the closest pharmacy to me to obtain it. The pharmacist told me that insurance denied payment, so I wound up paying out of pocket. I called customer service and was told that I had to go to their store for it to be covered. I explained that I live in the country and it’s over an hour to get to the closest one. She told me to “appeal” it by faxing over the receipt to the claims department. I typed up a letter and faxed it over, knowing that it would take a miracle for a reversed decision, seeing as they do not care where I live or how far I have to travel. My heart goes out to others in the same situation.

It reminds me of a few articles I read the other day. There are many people on fixed incomes whose insurance has denied their lifesaving treatment. If they decide to pay for it on their own, they usually have to cut back on things like groceries, paying certain bills or even heat. The other alternative is they just don’t take it, and their health worsens.

It’s not fair for these companies to force their customers into making tough choices. Some of them depend on these drugs to keep their cancer from spreading or IBD from flaring up. Also insurance companies may deny counseling for mental health patients even though it’s advertised by the company that they are supportive in helping those who have mental health issues. Why are they refusing to help? Is it false advertising?

Why don’t these businesses realize that lives are at stake if they are denied the very thing that would assist sick people in feeling better?

I only have one question for those “suits” who own and run these establishments.

If your wife, child, mother or father became seriously ill and needed specialty medication prescribed by their doctor to keep their symptoms from worsening or trying to get in remission, would you treat them the same way as you’ve treated us?

Getty image by Daniela Jovanovska-Hristovska

Originally published: January 11, 2022
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