Insurance Problems

Connor has been on depakote for four years. He takes 250 mg 3 times a day. This medicine is for his seizures. The only times he has had a seizure with it has been when his depakote levels, for whatever reason,  have fallen out of therapeutic range. That usually happens when he hasn't been getting all the doses or he has gone thru a growth spurt and the dose needed to be increased.

We dropped off the prescription to get a refill on Thursday. On Saturday we went to pick it up. When the pharmacist rang it up and told us how much it was, we were like um, no. it's covered under insurance. The only thing we should have to pay is the co-pay. After a long discussion, and the pharmacist calling the insurance company, we find out bceause there is a generic, the brand is no longer covered. The generic came out a while back. When it first came out, they filled it with the generic. We called the neuro, who called the pharmacy and had it changed to the brand. According to the neuro, generic seizure meds just don't work for most kids.

I called the neuro on Monday and let her know what was going on with his meds. She called the insurance company and got back to us today. The insurance denied her request for the brand. So then I call the insurance company. Still, they deny it. I ask them why they are denying him the medicine he has been on for four years and has proven to work. They really didn't have a good answer for me. I asked who made these decisions, and where did they go to medical school. I've been on the phone off and on all day trying to get his medicine covered, and nothing so far has worked. I was finally told me and the doctor could appeal thier decision, but that could take several weeks. So now, we have to write a letter to the insurance company, and so does his doctor, stating why we disagree with thier decision and why the medicine should be covered.

If Connor takes the generic, he will end up having seizures again. His seizures are always major, lasting at least 5 minutes, and he always ends up in the hospital afterwards. He's going to have to go thru all that just because some jack ass in a suit who has never met him thinks he knows better than Connor's doctor.