i've been on LDN since september 2009.
i haven't torn a tendon or ligament since. and prior to that i had a whole laundry list of torn tendons and ligaments, a few that took 1-2 years to heal enough for me to function. thus, the use of LDN is a big deal for me.
my rheumatologist prescribes it and i get it through one of the local compounding pharmacies in town.
Medco has reimbursed me for it since then, until recently.
a few months back, when we submitted two claims at the same time, Medco tried telling us that not only the active ingredients, but all inactive ingredients with the amounts and costs per ingredient had to be on the claim form. when we contacted the local compounding pharmacy, they told us that was ridiculous and that the insurance company was just "harassing" us and them.
after getting nowhere, we ate the cost of those two months, and just submitted the next claim. no problems, which really does feel like Medco was making things up.
now, after several more months, several more claims filed and payed for (minus the $25 copay), we got a denial letter, again. this time it says they don't pay for 90 day supplies from local pharmacies, only mail order. but when i talked to them about compounding pharmacies, i was told they were the exception, since compounded drugs can't be obtained via mail order.
so, i'll need to call them, again. they could have made a mistake, with the person handling the claim not realizing it was a compounded drug. they could have changed their policies without telling us. or they could simply be harassing us again. they really don't seem to like to pay for compounded drugs, as they really seem to like the whole mail order business.
i just hate to have to go back to every month vs every three months. the pharmacy is across town, out of our way (nothing else is over there to go to) and in the winter months it can be quite tricky to get there with the weather and the roads.
the other really odd thing is that they decided that the cost of the drug for one month would be $14.77 and that my copay was $14.77. the cost of the drug is ~$200 for three months, it was ~$80 for a month. i know i could get it cheaper from a place like skip's but like the idea of supporting my local pharmacy. where in the world did they all of a sudden get $14.77 from? its like they just made up numbers.
i know i'm lucky that at least i have a doctor that will prescribe it.
and i pay a lot more for all of my supplements that will never be covered by insurance.
i guess its just the principle and i hate feeling like i'm being harassed and hate feeling like they are just making things up as they go along.
anyone else that is on LDN have trouble with the insurance company paying for the LDN? how do you deal with it? or do you just suck it up and pay for it yourself?
Edited by Sue22 (06/02/12 03:51 AM)
Humira (no more methylpred or Aleve?)
vits C, D. probiotics. fish oil. CoQ, Mg, Ca
no dairy (casein sensitivity), limited eggs