Medication Denied!

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The other day I went to the pharmacy to collect my medications and was told my insurance company, Aetna, decided that they will no longer be covering my prescription for Diovan, a medication used for heart failure patients.

I am on Diovan for 7 years now and all of a sudden Aetna decided not to cover it, and I have to pay out of pocket for it. I called Aetna and asked what were my options and the representative told me that I can have my cardiologist A) Submit a pre-approval for the medication and it will be reviewed and Aetna will make a decision or B) Have my cardiologist switch to another medication.

I did option “A”, and my cardiologist submitted all the required documentation, and the request was denied. My cardiologist appealed the decision but Aetna said that I must first try one of the medications from a list they provided. I have to try at least two of the medications and have any allergic or adverse reactions to them before they will reconsider my prescription for Diovan.

Aetna is a great insurance company and I have been using them for almost nine years now, and i have very little to complain about. they pay all my claims and I never have to fight with them, but It really becomes scary when the insurance companies start calling the shots and making the decisions on what medications they will permit me to take without my paying out of pocket. I guess no matter, the insurance company always has the final say..

7 Comments Add yours

  1. carolee888 says:

    Holy Moly! Do you live in a state like California that has a board that you can get help from?

    Like

    1. Basil Rene says:

      No. I am in NY. What can I say? They pay the bills …

      Like

  2. Nancy Winningham says:

    Please appeal this. Most insurance companies allow you to appeal. You will be no worse off if they say no. I have appealed decisions and gotten some coverage on meds. Please appeal!

    Like

    1. Basil Rene says:

      My doctor did appeal, twice! Still denied. What can I say. If you only knew what my monthly insurance premium was! It is almost the the national income average, and that is no exaggeration.

      Like

  3. Nancy says:

    Also Love the pic on your post. It is a great expression of how I feel sometimes!

    Like

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