Sign in

or Register now

MyDiabetesCentral.com

See all of our health sites at www.HealthCentral.com
Friday, July, 25, 2008

Question
sharon
04/23/08
sharon
Category:Januvia insurance coverage

januvia insurance coverage

How can I get my insurance carrier to cover Januvia?   While waiting for a preauthorization for Januvia from my insurance my doctor gave me 28 days worth of 100 mg Januvia samples.  The insurance denied coverage of Januvia and said I must write an appeal.  I am currently on Metformin 2000 mg/day and Januvia 100 mg/day and doing great but hate paying full price for Januvia.  Please help!!   Thank you.

Answer This
Answers (1)
Dr. Bill Quick
Dr. Bill Quick
Close
Health Professional

Dr. Bill Quick and his wife Steph are the authors of one of the ...

Wednesday, April 23, 2008

I have addressed a similar question previously, at http://www.healthcentral.com/diabetes/c/110/21053/companys-denial/

 

To rephrase my earlier answer:

 

Arguing with an insurance company is always a multistep procedure.

First, has your diabetes specialist written on your behalf? Do you have copies of the correspondence? The letter must say that the medication is "medically necessary", and should document blood glucose levels, and what other medications have been tried (and failed).

Second, don't assume that the letter was received, if mailed or faxed to the insurance company. Send the letter again, this time by certified mail, with a return receipt requested.

And a copy should go to the Medical Director of the insurance company, not just to the routine address.

Also, send a copy to your employer, if your employment is funding your insurance. And talk to the Human Resources department at the company about what might be done from the employer to help.

Next, plan on rejection (which it seems is already occurring). Write again, and next time, make it clear that a copy is going to your employer (if employed) or to your Congressmen (if government-sponsored insurance).

And finally, document everything!

I have said, only partially in jest, that the first time you write, they throw the letter away. The second time they read it then throw it away. The third time they read it and write back. And the fourth or fifth time, you may eventually find a sympathetic soul who will allow the expense.

 

Keep on trying!

 

Ask a Question

Get answers from our experts and community members.

Answer a Question

Why does actos cause weight gain?

Answer This View all questions >

Important:
We hope you find this general health information helpful. Please note however, that this Q&A is meant to support not replace the professional medical advice you receive from your doctor. No information in the Answers above is intended to diagnose or treat any condition. The views expressed in the Answers above belong to the individuals who posted them and do not necessarily reflect the views of The HealthCentral Network. The HealthCentral Network does not review or edit content posted by our community members, but reserves the right to remove any material it deems inappropriate.