Oh No,Here We Go Again With Humana

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So,here we go again with Humana.
I'm about to scream. I'm so angry with Humana and there Bull Crap.

I'm trying to get my money back from all the money I had to pay for the Suboxone while they were playing there lil games.

I get a letter today telling me it was denied b/c I needed a PA. A AP??? Are you kidding me?
I spoke to someone and she said that when I got approved there was no approval for me to be reimbursed for the money I already put out. I told her I followed everything by the book and this was so wrong of what they keep doing to me.

She said I can write a letter,AGAIN to the Grievance Dept.. Now,what do they want me to write that I'm not able to put my bills any longer? That my rent needs to be paid? They don't care about that.
I assume all I can do is play there game again and fight for it as I've had to fight for the approval.

At this time I can't write them anything b/c I'm so angry. If I said what I wanted to say I'd end up getting my Suboxone cancelled.
Why do they insist on making this so hard for the lil guy?

Any sugesstions would be greatly appreciated.

Marie

The PA. Prior Authoriation.
Does it say that in the guidelines?

Again, it is up to the doctor (oh heck) to get the prior authorization for you.
Suggestions. As much as I hate to say this, call them and sweetly but with authority find out exactly what you need to do.
Let them know that if you had known you needed to get the PA you would have done so in the beginning.
I'm sorry Marie, with everything you have been through with the insurance company and not to hear this.
This is exactly why so many people give up and say to heck with it. To them it's just not worth it. Suboxone is too expensive to let it go though.
You have the patience of a saint. Seriously.
I'm here if you need to talk,
Dee

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It was a letter saying I was denied on 2 out of 5. I've not heard about the other 3 claims yet.
It was similiar to this.

5/2/2011..Suboxone8mg-2mg-Sl Film
Denied for..Prior Authorization.

I had 2 PA's during the process when I was doing my appeal?

I'm wondering if they want a PA for each time I filled a claim.
One of the ppl I spoke to says rarely do u get your money back. That they didn't approve for me to get it back. Makes no damn sense to me. They just trying to get out of paying.

I guess I'll have to call back now that I'm over the shock and try to understand better.
I'm wondering if they going to just deny those two? Those were each $108.00. I don't know if they trying to get out of the paying the 3 claims that are over 100.00,I have 3 of them out of the five.

The guy I spoke with earlier in the day said nothing about being denied and said he was sending it in as critial. Then when I told the lady I spoke to that she said he sent it to the wrong dept.
OMG,who do u believe?

Dee,I can't afford to let it go. I really need that money it's almost 500.00.

I thought I had this all resolved and have my daug. coming Thurs night. If it's not resolved by then maybe she can help me since she hasn't been dealing with it maybe she can make them understand or i can better understand if she talks to them.
I feel like they just running in circles and I'm friggin dizzy.

Marie,
Maybe with your daughter being fresh can have some insight. Take a step back and look at it out of the box.
Do you have a regular primary care provider that you use for other medical issues? Maybe if you do you can go see their insurance person and have them explain this to you. It might be worth a shot since they deal with this kind of stuff, billing etc.

I looked on the copy of the guidelines that I have and it says Suboxone requires a Prior Authorization. Usually when a drug like Suboxone being for maintenance the prior Authorization is good for one year.

I don't know if at this point you will get your money back. But seeing that you have now been approved, you might.
Sometimes when an insurance company approves you for a drug, the pharmacy and resubmit the medication for payment. Then it would be up to them to reimburse you once they receive their payment.

That is how it works here but I don't know about your State. Different States, different rules. And it bites.
Take a break today and tomorrow. Rest up until your daughter gets here. Turn on the radio to a station you like to listen to, go outside and work with your garden. See if you can re group.