I have Anthem Blue Cross/Shield preferred tier and have been experiencing chronic pain for years. I would go to walk in centers or my GP and get an RX for a anti inflammatory, muscle relaxer,etc to manage the pain. I finally went to see a specialist (Neurologist) who did several tests on me as well as blood work etc and by process of elimination documented I had Fibromylgia and prescribed Lyrica which I have used and worked great. Neurontin was like a sugar pill in comparison.
Fast forward....I get denied by the insurance company because they stated that the drug is only prescribed for specific diagnostics (Lyrica being one of them). I corrected them and told them that is what exactly was specified by the doctor! My doctor is then told he must fill a letter of authorization stating I tried all these different medicines to no avail.
I then still get rejected because I did not report pain for 3 months. Are you efn kidding me. My doctor basically said screw them and he is is giving me as many sample bottles as I need.
I am still going to fight this but this is the third occurance where the insurance company has rejected me with other drugs.
Here a licensed practicioner prescribes a FDA approved drug for this specific diagnosis and I still get rejected.
Sorry to vent but the patient is really the victim. I wish there was a way to fight this but what a way to create a black market.