anyone know about insurence co's?

[tboy72]

my insurence has been great untill yestarday.....can anyone tell me the laws on the ? im about to ask. so far if gotten them to pay for 3 bottles of 60 10 mg tabs of btg oxandrin. i know posting prices is against the rules here, but in this case all you have to do is call your local pham to find out that btg goes as high as $1100 a bottle. so they have shelled out $3300 for me so far and i still have 2 refills!
now when i got my first bottle it said 4 refills.....so does this mean the insurence co autherized all thoes refills? for what i gather it does........
now here the BIG problem. i went to get another script i NEED yestarday, in the past i have filled it 3 or 4 times. but yestarday they said they needed md's autherization. this med cost over 5 bills. so im thinking that the insurence co wants to talk to my primary care phyisician and have him fill out paperwork for this.....(cheap fucks) i DO NOT WANT THIS. IF THIS happens im in big fucking trouble! ok first off NEVER use different md's on your insurence 2x's in the same month on controlled substances. so if the insurence co talks to him they have the right (since i sighned the papers allowing the doc to speak with them) you have to inorder to be covered.............................
ok so i took the loss and paid cash for the med.......(i coulda have gotten a nice amount of gear for that price) but now...in the future...are they going to always ask for autherization for every expensive controlled scriped? and am i safe since the insurence co autherized all the refills on the ox.?
i know if they ask for autherization from the doc i can get her to say the reasons i need it....I WONT NOR SHOULD any of you say its for muscle wasting syndrom from aids....then you may be fucked down the road if you have to switch companies.i tell her to sai i have nerv damage in my back witch is causeing my lower lumbar to deteriate. that should be sufficiant since i do have 5 herniated disks and it caused my left leg to go numb from above the knee to the hip.
NOW PLEASE...anyone whith any knowledge (NOT OPINIONS) help me!




thanks

 

[tboy72]

bump....i know there is some who can help me

 

[searay]

i had the same thing happen. i had scripts for arimidex and btg anavar. the first scripts went right through and i got approval for 2 refills. the second time i tried it the ins. co. aproved the arimidex but not the anavar. they wanted me to go to my primary care physician and get his approval, ya right. i just took the arimidex and forgot about the btg. i figured the first 3 months was a freebee. i kinda figured the ins. co. would catch wind of how expensive the btg was and eventually cut it off.

 

[carlsky]

that's how it work, they want you to pay high insurance rates, but when the time comes for them to cough up some good green, there nowhere to be found. At least that is what it is like for me.

 

[tboy72]

i had the same thing happen. i had scripts for arimidex and btg anavar. the first scripts went right through and i got approval for 2 refills. the second time i tried it the ins. co. aproved the arimidex but not the anavar. they wanted me to go to my primary care physician and get his approval, ya right. i just took the arimidex and forgot about the btg. i figured the first 3 months was a freebee. i kinda figured the ins. co. would catch wind of how expensive the btg was and eventually cut it off.

thanks for the reply bro....they covered 3 bottles already and i still have 2 refills. does that mean they approved the refills?
also did you have any problems getting other meds covered after?

 

[glennds]

i am an insurance man. sell health ins thru blue cross as well as many other lines of business. i dont have time to post now but will later.

 

[tboy72]

i am an insurance man. sell health ins thru blue cross as well as many other lines of business. i dont have time to post now but will later.

that would be a huge help!

 

[Ulter]

There is no definitive answer bro. I did health insurance claims for 7 years. It's all up to the policy you have and what it says. NO, they did not approve the refills. The approval comes at the time the drug store rings it up.
The company will also probably not approve more than a certain amount of oxandrolone per 30 days.
In seayray's situation, the policy is HMO, so they want searay to go to "their guy" so he can dump that script.
Oh and pay no attention to that $1100 dollars. The insurance companies have "deals" they make to keep their costs down. They would likely pay only a few hundred of that. But the drug store doesn't want you to know that.

 

[glennds]

now when i got my first bottle it said 4 refills.....so does this mean the insurence co autherized all thoes refills? for what i gather it does........
now here the BIG problem. i went to get another script i NEED yestarday, in
thanks

no offense tboy but your grammar is terrible, had trouble getting thru this post. hope i understood it.

your doc tells the pharmacy how many refills you can get, i.e. 4 refills. after you have filled it the fourth time your doc must authorize a refill. the pharmacy would love to refill it but your doc must ok it.

your problem is not with your insurance company. you should have planned for this before your prescription ran out.

it is highly unusual for a doctor to prescribe a medication with unlimited refills. he must moniter usage. he has his malpractice to think of.

your insurance company will pay for your BTG if your doc authorizes, provided your coverage is current. BTG is often prescribed for illnesses such as AIDS, and cancer. i doubt there is any limit on the amount you can get per year of this particular drug.

 

[tboy72]

There is no definitive answer bro. I did health insurance claims for 7 years. It's all up to the policy you have and what it says. NO, they did not approve the refills. The approval comes at the time the drug store rings it up.
The company will also probably not approve more than a certain amount of oxandrolone per 30 days.
In seayray's situation, the policy is HMO, so they want searay to go to "their guy" so he can dump that script.
Oh and pay no attention to that $1100 dollars. The insurance companies have "deals" they make to keep their costs down. They would likely pay only a few hundred of that. But the drug store doesn't want you to know that.

thanks utler ive heard the same thing about insurence co's making deals with drug manufactuars. but its not bullshit when someone needs the meds and insurence wont cover it.....then $1100 is no bullshit cause you gotta pay it!
i did however call my insurence co about the med they wouldnt approve (that i actually needed) they said i have to go through all this bullshit. however they did mention that the refills would be honored! or?

 

[searay]

you should be good to go on the refills. once the original script is approved with refills you get the refills without having to deal with another approval. the problem with my scripts was that they were written by someone other than my primary care doc. i was really supprised the first script went through. the other issue is that the ins. co. will notifie your primary care doc of whats going on. after my ordeal with the scripts i had to go see my primary care doc cause i hurt my back and he starts going on and on about how the hmo's notifie him when people refill scripts sooner than there suppposed to, so i figured he was just letting me know that he knew about me getting aas from someone other than him. i just played stupid and made believe i didnt understand what he was getting at.

 

[tboy72]

no offense tboy but your grammar is terrible, had trouble getting thru this post. hope i understood it.

your doc tells the pharmacy how many refills you can get, i.e. 4 refills. after you have filled it the fourth time your doc must authorize a refill. the pharmacy would love to refill it but your doc must ok it.

your problem is not with your insurance company. you should have planned for this before your prescription ran out.

it is highly unusual for a doctor to prescribe a medication with unlimited refills. he must moniter usage. he has his malpractice to think of.

your insurance company will pay for your BTG if your doc authorizes, provided your coverage is current. BTG is often prescribed for illnesses such as AIDS, and cancer. i doubt there is any limit on the amount you can get per year of this particular drug.

ok i guess i didnt proof read so that probably explains why you didnt understand my situation. on the original script she wrote out oxandrin 10 mg bid #60, then for refills she wrote 4. so i still have 2 more refills. my problem was with another drug that they used to fill. i was just worried that since ive been using my insurence a lot latley, they wouldnt give me the 2 more refills i have.
so my prescription has not run out. i still have 2 more refills that i hope they cover......................and thats what i was wondering.
searay understood where i was at, and i thank both of you for your replies.

 

[glennds]

ok. i was just worried that since ive been using my insurence a lot latley, they wouldnt give me the 2 more refills i have.
.

an insurance policy is a contract that is binding on both sides. your insurer cannot deny a valid prescription simply because they think you are "usingyour insurence a lot latley." (sorry, that was a diss on your spelling )

as long as your premiums are current you will be covered. the only way they might decline is if you have exceeded the policy limit. this is unlikely unless you have some real cheap policy with a cap on drug benefits. a payout of $3,300/yr in drug benefits is not much these days.

another reason a drug may not be covered is if it is considered for cosmetic purposed, i.e. Propecia.

 

[tboy72]

an insurance policy is a contract that is binding on both sides. your insurer cannot deny a valid prescription simply because they think you are "usingyour insurence a lot latley." (sorry, that was a diss on your spelling )

as long as your premiums are current you will be covered. the only way they might decline is if you have exceeded the policy limit. this is unlikely unless you have some real cheap policy with a cap on drug benefits. a payout of $3,300/yr in drug benefits is not much these days.

another reason a drug may not be covered is if it is considered for cosmetic purposed, i.e. Propecia.

thanks bro! as for the spelling........a)im dyslexic b)im lazy. bad combo huh?
but your info is helpful....thanks!

 

[Ulter]

but its not bullshit when someone needs the meds and insurence wont cover it.....then $1100 is no bullshit cause you gotta pay it!

That's not what I said. I said when the insurance company pays the claim to the drug store that's not what they pay. It's what YOU pay if you don't have insurance, but not what they pay.

 

[tboy72]

misunderstanding.......................but it still sucks to be at the mercy of the insurence co, and sucks worse if your uninsured!