This weeks allergy topic brings up an issue that we have never faced and I am wondering do others. Last week I encountered a nightmare with our insurance company and a denied claim to fill a medication that has been a miracle drug for our son. He has been hit hard by the asthma and pneumonia this season and thus drugs have unfortunately become a bigger part of our lives. We have been on a mission to find the right drug(s)to keep his asthma under control. It has been a long road.
Last month we decided to start Singulair after we tried Flovent, Asthmanex and Qvar. It has been an amazing drug for him and he finally was sleeping through the night for the first time in a long time. Our allergist has been so wonderful to give us many samples of all the drugs except the Asthmanex but now it is coming back to bite us in the behind. He gave us several Qvar inhalers of a higher dose and he was doing well so he gave us several inhalers of a lower dose. Then January cold season came on with a vengeance and we did 2 rounds of antibiotics for pneumonia and are actually now doing a 3rd round. So we decided to go with Singulair to get a head start on the allergy season. He gave us one month of that. I then went to fill the Singulair and the insurance company denied our claim because we did not have a filling History at the pharmacy of trying other drugs first due to the samples. SO I just received a letter from the insurance company and if I want them to fill it I have to jump through ridiculous hoops!!
Consequently now that he is off the Singulair he has gone down hill. Despite the fact that we have started now Advair. So much so that we almost had to have him admitted to the Hospital yesterday and as stated earlier we are doing a 3rd round of antibiotics for pneumonia yet again. SO would we rather pay for this drug or pay for a hospital admission? Would we rather pay for this drug or continue to pay for Countless Urgent Care visits and ER Visits? Hmmm? Seems like a no brainer to me. If we filled the Singulair I see the potential that it would be the only drug we would need. So now they have to pay in part for Ventolin, his rescue inhaler. Advair, his longterm inhaler and every other antibiotic we seem to need every other month. Does not seem smart. I will be calling the insurance company most likely later on today. I will post an update of what I learn.
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