For nearly 8 months, I have been fighting with my insurance company about a pre-authorization for my compounded thyroid medication. And today, I won.
It really didn’t make sense that the insurance company was initially denying coverage for my thyroid medication once I increased the dosage in March. Everything was the same with the prescription, other than taking one more pill per day, which meant 30 more pills in a monthly prescription fill. They recognized and approved coverage for the prescription last year, so it wasn’t the pharmacy or that it was compounded. And Blue Shield even would refund me for the copay once I filed a private claim each month. But that repetitive paperwork was getting old really fast.
So I had my doctor file another pre-authorization form for the prescription change — that was back in March. And I had my pharmacy send all the information needed (more than once actually). But still, no coverage on the medication. For 8 months, I called the insurance company who blamed it on the pharmacy. When I called the pharmacy they blamed the insurance company. I even received a letter in the mail from Blue Shield saying that they were no longer going to cover prescriptions from my particular compounding pharmacy — which is ridiculous! The pharmacy said it was a mistake and cleared up that miscommunication, thankfully. But this is the typical game they play with patients.
And finally, today I got a phone call that my insurance company has approved the pre-authorization for this medication (took long enough!). So instead of paying $119.00 out-of-pocket each month and waiting over 2 months to get reimbursed by the insurance company, I will finally pay the correct copay of $15 for this medication. I am ready to celebrate!! This pre-authorization better last through next year…seriously.