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Old 08-11-2019, 01:15 PM   #1
Senior Member
Join Date: Nov 2005
Posts: 245
A couple of words in handling insurance rejection.

I recently found out one of the reason the insurance reject covering a particular drug. The reason is incomplete or inaccurate information on forms that a clinic fill out to send to insurance company. It’s not easy to find the reason a drug is rejected from getting covered. It takes gentle persistence to find out. If you have a case manager (a person work for the insurance company supposedly in charge of your case), try to develop a positive relationship with this person right away.

Once you find out if the reason is missing or wrong information, it again will take gentle persistence to get the clinic person to refill the form and send it back in. It’s likely a clinic clerk will put up resistance in redoing this, (even if he/she or someone in the clinic messes up, it can even be the physician) since it will take more work. Sometime the missing information can be ridiculously trivial such as what’s the disease (I’m not kidding) or missing signature. Regardless a new form need to fill out and taken back to the physician for signature, more work. This can take several iterations, requiring more patience from us. Sometime it’s not missing information but it’s more likely the way information are presented. This usually require a person from the insurance company call the clinic and walk the person at the clinic through the appropriate steps. This will most certainly test your patience and diplomatic skill in persuading and coordinating all parties. I am of course not really that patient, there are indentations in the garage wall where I punch to take out frustration. Of course sometime after all this, the drug still will not be covered. In any case, once or twice per year, particularly during Holidays or randomly, buy chocolate/donut/pastry for the whole clinic, if nothing else it’s for thanking all the caring nurses. If we are lucky, it will be a very long battle that will end when a cure is discovered, and we need all means to fight the war.

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