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I've been fighting w/ the insurance companies about my DS Alimentum formula, since June they've been DENYING his Rx to eat, saying I wasn't doing enough & that it wasn't a necessity.
This past time of doing the prior-authorization & appealing, I included the specialists letters that I had them send me, and then, I wrote a personal letter to the insurance company, letting them know about Teighan's allergies & skin disorders. I was about to drive to the insurance company's headquarters (an hour away) & sit there on their doorstep at opening time w/ my child & photographs to show & insist on talking to the top.
I called the pharmacy, they said it was still denied. I called the doc's office, still denied. I called the insurance company, was put on hold, transfered & then hung up on. After almost saying "forget it" (cuz it's Friday) I called one more time, and got Caroline from the insurance company telling me that it was approved & that the insurance co. hadn't removed the "lock" on it yet. She said she was going to have that done ASAP & that it was approved for 6 more months. Yeah, it's not for a year, but it's 6 more months of not having to freak out of how we'll pay for this.
I could have reached through the phone & hugged her. I told her "you have no idea how happy you've made me today, thank you, thank you!" she was laughing but I told her how hard I've been working to get it approved & to finally hear "yes" was more than I could ask for today. Well.. I could ask for more, but I wont.
Just thought I'd share some "happy" news for a change. I'm always posting about struggles & this was a happy ending...for another 6 mos.
I got a call back from the insurance company & they are backdating it to August & pulling it further until August of 2010, so I'll get reimbursed for out of pocket spending on his formula "and" a longer time frame to get his formula too. This is great news for Teighan!