Virginia Consumer Healthcare Alliance

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From the Alliance

Prescription denial by insurance companies

I am a 54 year old female who has suffered with severe pain for more than 10 years. I have kidney and liver disease that cannot be corrected without transplant. At this time that is not an option because both the kidneys and the liver are functioning well. My primary care physician has given me a narcotic for pain control. This is Percocet. That worked for the first several years. When I told my physician I was having an increase in pain he suggested I go to pain management. I agreed and they said I should try the medication Methadone. I refused. Too many people automatically assume you are a drug addict and not taking it for pain control. I seriously suffered in pain for two years before I gave in to pain management. Fast forward to last month I pick up my two prescriptions from my primary care physician that I have been filling for approximately 6 years and we go to fill them and the pharmacy tells me my insurance company no longer approve my Percocet. WHAT? I just filled it last month. I haven’t received anything in the mail that we have had a change to our policy. So I contact Federal Employee Blue Cross Blue Shield and they tell me my doctor needs to only fill out a pre-authorization form. My doctor did this and then the insurance company denies my Percocet. They make the decision it isn’t necessary. My doctor stated it is but the insurance company thinks they know better. They don’t know me better than my doctor. What right do they have to make a decision different than what my doctor says? Also, you CANNOT stop Percocet without weaning someone off if it. But the insurance company thinks they know everything. Obviously not! I pay for this insurance. It is about time they realize that the consumer is tired of being jerked around.