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pablohoney

Insurance -- ridiculous

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I recently completed a six month course of Accutane. I'm happy with the results and glad to be off it, but the derm didn't want me to stop all treatment, so she prescribed Retin-A micro for the next few months, with a follow up appointment in May. Unfortunately, I started a new insurance program this year (with massively scaled back benefits, if you can't guess) and that's where the fun began.

I take the prescription to the pharmacy -- insurance declines it. Pharmacy talks to insurance. Insurance finally says they'll cover it, but since I haven't used up my deductible (I'm stuck in a high deductible plan, which covers NOTHING until I've exceeded $1100 in medical costs in the year) all I get is their "discounted price", which only drops it from $170 to $130 for a single bottle.

So I call my derm and ask for a prescription that allows generics. Derm calls in a new prescription for Tretinoin, any brand. Again, the insurance rejects it. Retail cost of generic Tretinoin -- $140. If I pay the retail cost without going through my insurance, not only do I get the higher price, but it doesn't even count against my deductible, so there's NO way I'm doing that. This time the pharmacy was no help -- they said to call my doctor and have them talk to the insurance company.

I call the insurer myself since it's after hours. The person I talk to says my plan requires a "doctor's diagnosis" for Tretinoin to be covered. WTF is a prescription if not the result of a diagnosis??? They're not really sure what it means, but they suggest I have the doctor call in and they'll figure it out. I ask them what the reduced cost would be, because if it's just another slight discount, it's not even worth the trouble. They can't tell me. Computer won't give the cost until the doctor's diagnosis requirement is overridden.

I hang up and leave a message at my doctor's office to cancel my next appointment because I'm discontinuing any further treatment (which on the bright side will save me another $100 appointment that I'd have to pay out-of-pocket).

If the insurance company's goal is to make the process as difficult and frustrating as possible to discourage claims, they are doing a really great job.

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I'm dealing with the same thing right now. I want something cheaper than the Green Cream I've been using, but I don't want something really strong that will irritate my skin. They said they'll cover all but $30 for RAM up until the age of 29, they won't cover Renova, they won't cover the generic of Renova (tretinoin emollient .05%). I hate insurance. I have this problem with other prescriptions too. What good is insurance if it won't cover anything I need? I just had laser eye surgery and needed prescription eye drops, and insurance wouldn't cover them, so I had to pay almost $100 for them.

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I am having the exact same problem with my insurance company. I tried to get my prescription filled for retin-a micro and the pharmacy said that my insurance co. wouldn't cover it because of my age. If it is for cosmetic reasons insurance won't pay, but if its for acne they will . I went through the run around for several weeks and just said screw it and use my daughters retin-a. My doc suggested that we share in the first place to save money so this is okay but I really think it is dumb of the insurance co. to do this but I guess it isn't uncommon. :cry:

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