Doctor and insurance diabetes medication issues

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here.

I met with my doctor again this afternoon. He complained that he doesn't get paid extra for filling out prior authorizations and that it takes too much of the staff's time.

I gave him the fax number to send the chart notes, so all he has to do is fax them over to my insurance company. I called my insurance company to verify.

Later in the afternoon, I received a message from a nurse at the doctor's office asking what medication it is that I want him to prescribe. This was disheartening because it has already been prescribed.

I am so frustrated. I don't know what to do. My blood glucose levels are in the mid-200s and spiked into the mid-300s this weekend. I was nauseous and sleepy.

I don't know what to do.

Find a new doctor.

+1 If you have blood glucose in the mid-300s, you have bigger problems than lack of insurance coverage.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here.

I met with my doctor again this afternoon. He complained that he doesn't get paid extra for filling out prior authorizations and that it takes too much of the staff's time.

I gave him the fax number to send the chart notes, so all he has to do is fax them over to my insurance company. I called my insurance company to verify.

Later in the afternoon, I received a message from a nurse at the doctor's office asking what medication it is that I want him to prescribe. This was disheartening because it has already been prescribed.

I am so frustrated. I don't know what to do. My blood glucose levels are in the mid-200s and spiked into the mid-300s this weekend. I was nauseous and sleepy.

I don't know what to do.

Find a new doctor.

+1 If you have blood glucose in the mid-300s, you have bigger problems than lack of insurance coverage.

Is your doctor trying to get a lawsuit? He is not treating your obvious medical problem.

[Anonymous]

Anonymous wrote:I'm a type II diabetic. I was diagnosed back in February. I tried metformin and glipizide, but my a1c just kept going up and the meds gave me diarrhea (especially metformin). My doctor prescribed mounjaro back in April, but my insurance denied it.

I just switched insurance companies this month and tried to get mounjaro approved again. My doctor won't resubmit the chart notes and labs, saying he has already done it and that now it is my job to talk to my insurance company about it. When I talk to my insurance company, they say that they need to see the chart notes and labwork before they can approve any of the glp-1 drugs.

What do I do if my doctor isn't willing to resubmit the information to my new insurance company, but my insurance company requires it before approval of the drug?

Meanwhile, I'm living with an a1c of 9.1, and blood sugars frequently in the mid-200s.

I've been seeing this doctor for 9 years, and I previously thought we had a good professional relationship. I feel hopeless and depressed about this.

You told them you have a new insurance company and they denied completing the prior auth? If so, tell them to kick rocks and submit a complaint to their board.

[Anonymous]

Anonymous wrote:Here’s what my doctor emailed me yesterday when I asked him to send the note and lab work to the new insurance company:

“As always mentioning before, this is extremely frustrating for patients (and we physicians) alike. Insurance companies repeatedly are telling patients that all we simply need to do is fill out paperwork, send them lab results, chart notes, etc. and these medications will be covered benefits. Repeatedly they have been denied for reasons we do not know

As I mentioned to you before, please bring this up with your insurance company and asked them "what criteria you need to meet for these to be approved". It does appear that these are approved benefits though if insurance continues to deny these despite efforts that they wish us to do, we simply have no control

Finally, you may wish to check and see if there are other GLP 1 weekly injection medications that are covered benefits. The 3 products on the prescription market would include Ozempic, Trulicity and Mounjaro

Good luck with your efforts here”

Ok OP now that I read the information above I am going to give you some advice from someone who worked on prior auths for mental health and has also facilitated prior auths for my husbands complex medical needs.
He isnt saying no outright he is saying that you need to call your specific insurance company and get the information on when they will approve it, what conditions, what needs to be trialed- is it a step up basis, etc? Do they not cover any GLP 1s or do they cover one besides mounjaro? For the step up basis you need to determine how long they expect you to have tried other medications, how many, which, for how long, and what symptoms are necessary to show.

His frustration is misplaced and whats happening is they are doing the legwork of completing a PA and then being denied because it doesnt meet each specific insurance contracts fine print. Hes telling you that you will have to communicate with insurance and then give them the information. Shite I have filled out the PA forms for doctors before, including ones I worked with.

You need to review your pharmacy formulary specific to your insurance. You cant just look up Cigna for example. You need to sign into the website using your ID number and review your coverage. Search for the pharamcy formulary to determine what medications are covered and at what tier. The company may require that you do 2 Tier 1 meds for example for X months. Do you have a copy of the PA that the doctor sent to the previous insurance company? See what codes they used and language.

[Anonymous]

OP here.

I did contact my insurance company. They said that they would cover any of the GLP meds as long as it is documented that I have Type II DM.

I spoke with the manager at my doctor's office this morning and asked that the chart notes and lab work be sent to my insurance company.

When I checked with the insurance company a couple of hours later, they said they had received the chart notes, but that my birthdate was left off the prior authorization form, so it needs to be resubmitted with the proper identification.

I am very frustrated with my doctor's office. Such basic things they refuse to do, then do incorrectly.

My doctor spends the entire appointment complaining about how paperwork is such a pain, but when I asked him what I should do for blood sugar in the mid-300s, he said, "Well, what do you expect, you have uncontrolled diabetes."

Is my future just one of diabetes and complications? I am very worried.

[Anonymous]

I swear OP is starting to sound like he’s trolling us.

[Anonymous]

Anonymous wrote:OP here.

I did contact my insurance company. They said that they would cover any of the GLP meds as long as it is documented that I have Type II DM.

I spoke with the manager at my doctor's office this morning and asked that the chart notes and lab work be sent to my insurance company.

When I checked with the insurance company a couple of hours later, they said they had received the chart notes, but that my birthdate was left off the prior authorization form, so it needs to be resubmitted with the proper identification.

I am very frustrated with my doctor's office. Such basic things they refuse to do, then do incorrectly.

My doctor spends the entire appointment complaining about how paperwork is such a pain, but when I asked him what I should do for blood sugar in the mid-300s, he said, "Well, what do you expect, you have uncontrolled diabetes."

Is my future just one of diabetes and complications? I am very worried.

It sounds like whoever handles the prior-authorization is careless. I would switch doctors.

[Anonymous]

Switch doctors and/or contact an attorney.

[Anonymous]

Please demand the tests for type I diabetes. I know multiple people diagnosed at 50+ it's not just kids

[Anonymous]

Anonymous wrote:Please demand the tests for type I diabetes. I know multiple people diagnosed at 50+ it's not just kids

I think OP needs to find a new doctor first. Doesn’t look like his doctor can handle basic care.

[Anonymous]

Get a new doctor or offer to pay to have the submit the notes.

[Anonymous]

Anonymous wrote:Please demand the tests for type I diabetes. I know multiple people diagnosed at 50+ it's not just kids

Yeah I’ve been T1 for 30+ years (now in 60s) and op does sound like T1 to me. Op, there is a test you can do to confirm. You better get it under control if you want to stay alive later on