My mother's MS medication
Beschermde donatie
I need $1317.50 to get my Multiple Sclerosis medicine.
Back in September of 2013 on of my neurologist wanted to do a botox treatment on me for headaches. I had gotten pre-approval for it from my insurance and I had met my deductible so my out of pocket was going to be $0, so I decided to do it. I had the procedure done, and the effect/relief of the headache was short lived so I only had the 1 treatment.
Fast forward to February of this year (2015) and my specialty pharmacy says they can no longer ship my tecfedera because there is an outstanding balance of $1317.50 on my account. I am shocked.
I asked where it came from. It was from that botox treatment. Turns out it was denied in November, after I had the procedure done.
Optum, the specialty pharmacy suggested that I call tecfedera directly for the monthly shipment while I work it out with the insurance company. I called and they were able to ship me 1 month supply. They said they can't help me with the balance because it's not the result of their medicine.
I called the insurance company and they said the treatment had never been approved. After several weeks of calls and emails back and forth they finally agreed that I had been approved and the denial was in error but I didn't appeal it within the 180 days that they allow so I am out of luck. They can't help me.
I called the Ohio Department of Insurance to file a complaint and was told that an insurance company can deny a claim up to 2 years after the procedure takes place. I would never have had the procedure done if they hadn't given me an approval code and I hadn't already met my deductible!!!
I haven't been able to get my MS meds since March. So I talked to my doctor and he explained that while what the insurance company is doing is morally wrong, what they are doing is legal. He told me to call the pharmacy and see if they would take a payment plan. He said they'd probably take any amount because right now they are getting nothing at all. Which is what I can afford. Because come on, if I could afford $1300 I would have already paid it to get my MS meds again!
The specialty pharmacy told me they could only take a payment plan that is $329.00 a month. I can't come up with that. I have 2 kids in college (at home) and 1 in high school. I'm on disability.
I tried Tecfedera again, to see if they have any assistance programs, and they said since I am already on co-pay assistance, they can’t help me. They suggested that I call the Botox company (Allergan) to see if they can help.
So I called Allergan. They do have an assistance program. If I had just had the procedure within the last 90 days, they’d be able to help me. They suggested I check with The Healthwell Foundation or the Patient Assistance Network.
The Healthwell Foundation is only accepting applications from MS patients on Medicare and the Patient Assistance Network is not accepting applications at this time.
So here I am, I do not know where to turn. I haven’t had my MS meds since March. I’m not sure what that means in terms of how my illness is progressing, but it’s probably NOT good. I need help.
Back in September of 2013 on of my neurologist wanted to do a botox treatment on me for headaches. I had gotten pre-approval for it from my insurance and I had met my deductible so my out of pocket was going to be $0, so I decided to do it. I had the procedure done, and the effect/relief of the headache was short lived so I only had the 1 treatment.
Fast forward to February of this year (2015) and my specialty pharmacy says they can no longer ship my tecfedera because there is an outstanding balance of $1317.50 on my account. I am shocked.
I asked where it came from. It was from that botox treatment. Turns out it was denied in November, after I had the procedure done.
Optum, the specialty pharmacy suggested that I call tecfedera directly for the monthly shipment while I work it out with the insurance company. I called and they were able to ship me 1 month supply. They said they can't help me with the balance because it's not the result of their medicine.
I called the insurance company and they said the treatment had never been approved. After several weeks of calls and emails back and forth they finally agreed that I had been approved and the denial was in error but I didn't appeal it within the 180 days that they allow so I am out of luck. They can't help me.
I called the Ohio Department of Insurance to file a complaint and was told that an insurance company can deny a claim up to 2 years after the procedure takes place. I would never have had the procedure done if they hadn't given me an approval code and I hadn't already met my deductible!!!
I haven't been able to get my MS meds since March. So I talked to my doctor and he explained that while what the insurance company is doing is morally wrong, what they are doing is legal. He told me to call the pharmacy and see if they would take a payment plan. He said they'd probably take any amount because right now they are getting nothing at all. Which is what I can afford. Because come on, if I could afford $1300 I would have already paid it to get my MS meds again!
The specialty pharmacy told me they could only take a payment plan that is $329.00 a month. I can't come up with that. I have 2 kids in college (at home) and 1 in high school. I'm on disability.
I tried Tecfedera again, to see if they have any assistance programs, and they said since I am already on co-pay assistance, they can’t help me. They suggested that I call the Botox company (Allergan) to see if they can help.
So I called Allergan. They do have an assistance program. If I had just had the procedure within the last 90 days, they’d be able to help me. They suggested I check with The Healthwell Foundation or the Patient Assistance Network.
The Healthwell Foundation is only accepting applications from MS patients on Medicare and the Patient Assistance Network is not accepting applications at this time.
So here I am, I do not know where to turn. I haven’t had my MS meds since March. I’m not sure what that means in terms of how my illness is progressing, but it’s probably NOT good. I need help.
Organisator
Alice Rae Hall
Organisator
Blacklick, OH
