Anonymous wrote:United healthcare sucks!!! We finally found a medication that my son can take that wont cause horrible side effects and they wont cover it
We went through the appeal process with our Drs and they tell us there is nothing to appeal as they do not even admit to Quillivent's existence??? Well, I don't know how to argue with stupid... It obviously exists as I have a prescription for it and have tried it previously- out of pocket they want $400!!! I called Pfizer in hopes that they would have some sort of assistance for people getting the BS UHC hands out over non-existing drugs Pfizer produces, and they are more a headache than UHC!! Ugh no help at all!
My husband owns the company of which we are provided this insurance, and he will definitely be leaving UHC to find some provider that can bring their head out of their AXX

Pfizer has a dedicated customer service line just for Quillivant 855-867-8034. Did you call that number?

Anonymous wrote: It's very unfortunate that people have to jump through hoops to get the proper medication for their children.

Given the level of the abuse of this and similar drugs, it doesn't bother me in the least to do the precerts if it is going to stem the tide of abuse and misuse.

We don't have UH, but I've had to do pre-certifications with my Blue Cross/Blue Shield policy for Methylphenidate for several years now. It's very unfortunate that people have to jump through hoops to get the proper medication for their children.

Anonymous wrote:We just switched to UH and my son has been taking Methylphenidate since 2012. He is finally doing great on the dosage we have him on and feeling successful. He is 13 years old and I can't get it refilled with UH. I'm not happy and on hold waiting for a manager who will tell me WHY they are doing this. I figure it's because of kick backs they are getting, but as I told the girl on the phone very verbally you do NOT mess with this type of medications when they are working for an individual. It's a struggle each day just to deal with the real world and others not understanding, now they want to make it even harder for people and forcing them to make a quick change. A 13 year old has enough changes going on in his life and I'm just sick to my stomach that I need to switch him now.

Is this one of the medications for which UHC requires precertification? If so, if your doctor's office is cooperative, you can usually accomplish that in a day or even a few hours. I have never had trouble getting this prescription filled, but I do have to do the precertifications. With our plan, precertifications started at age 13, which hit me by surprise at the time. They have to be redone annually.

We just switched to UH and my son has been taking Methylphenidate since 2012. He is finally doing great on the dosage we have him on and feeling successful. He is 13 years old and I can't get it refilled with UH. I'm not happy and on hold waiting for a manager who will tell me WHY they are doing this. I figure it's because of kick backs they are getting, but as I told the girl on the phone very verbally you do NOT mess with this type of medications when they are working for an individual. It's a struggle each day just to deal with the real world and others not understanding, now they want to make it even harder for people and forcing them to make a quick change. A 13 year old has enough changes going on in his life and I'm just sick to my stomach that I need to switch him now.

I'm not familiar with this forum so I'm sorry to intrude. But a lot of these issues I k ow how to get around. It's not easy but it's not hard either once you know what to do.
And the process literally works for practically anything being prescribed off label or that the insurance company is denying and requesting "medical" evidence. I have two rare sleep disorders that are chronic. I take 50mg adderall to stay awake while I'm moving. It still doesn't help if I'm sitting down or bored. But after two years of fighting with multiple insurance companies through Medicaid managed care (UHC, Molina, Buckeye, and care source) all kept denying me bc adderall isn't approved for sleep. It's only approved for ADHD.
So it took a lot of research but they'll never be able to deny me any drugs for my conditions again. It's a shame that this all kept secrete from patients. The burden of proof should be on the company.

Anyway. It's too many links to put here. It won't let me. Ummm.

My email is sbanner84@ameritech.net just put something obvious in the subject please. You can also message me on facebook I'm always available there. Facebook.com/benginbanner (Sam Banner, my profile pic is a memorial with a man in an army uniform but I'm a girl. lol I feel compelled to tell people that when I'm not using my own face as a picture or everyone addresses me as a man.) hopefully I can help. These comments are old. So with any luck everyone will have it situated already!

Anonymous wrote:United healthcare sucks!!! We finally found a medication that my son can take that wont cause horrible side effects and they wont cover it
We went through the appeal process with our Drs and they tell us there is nothing to appeal as they do not even admit to Quillivent's existence??? Well, I don't know how to argue with stupid... It obviously exists as I have a prescription for it and have tried it previously- out of pocket they want $400!!! I called Pfizer in hopes that they would have some sort of assistance for people getting the BS UHC hands out over non-existing drugs Pfizer produces, and they are more a headache than UHC!! Ugh no help at all!
My husband owns the company of which we are provided this insurance, and he will definitely be leaving UHC to find some provider that can bring their head out of their AXX

You should have your husband call his broker and tell him that. The broker has a financial incentive to keep the business and will (hopefully) do what s/he can to reach out to the insurance co.

United healthcare sucks!!! We finally found a medication that my son can take that wont cause horrible side effects and they wont cover it
We went through the appeal process with our Drs and they tell us there is nothing to appeal as they do not even admit to Quillivent's existence??? Well, I don't know how to argue with stupid... It obviously exists as I have a prescription for it and have tried it previously- out of pocket they want $400!!! I called Pfizer in hopes that they would have some sort of assistance for people getting the BS UHC hands out over non-existing drugs Pfizer produces, and they are more a headache than UHC!! Ugh no help at all!
My husband owns the company of which we are provided this insurance, and he will definitely be leaving UHC to find some provider that can bring their head out of their AXX

Anonymous wrote:

Anonymous wrote:Could someone please help me find the link to the appeals process?? Have looked all over United Healthcare. I am stumped. I can only find medicare info. But I need just regular appeals. Focalin is the safest drug with the least side effects and we finally got here after a lot of face twitching and other queer symptoms with others.

We have United Healthcare and last year, they sent a letter saying DC's Straterra would not longer be covered. However, in the letter after the large print there was a small print that said if you and your doctor disagree call x number (which turned out to be the wrong number). However, I called and got the correct number and his doctor had to call and go through some hoops, like informing them that DC was allergic/bad side affects for every drug they were suggesting to replace. They granted one year. So, we have to go through it all again next year.

Actually we will need just 6 months or so in addition to that and then it is off patent and we can use the generic that has been available out of the country fro several years now.

Anonymous wrote:Could someone please help me find the link to the appeals process?? Have looked all over United Healthcare. I am stumped. I can only find medicare info. But I need just regular appeals. Focalin is the safest drug with the least side effects and we finally got here after a lot of face twitching and other queer symptoms with others.

We have United Healthcare and last year, they sent a letter saying DC's Straterra would not longer be covered. However, in the letter after the large print there was a small print that said if you and your doctor disagree call x number (which turned out to be the wrong number). However, I called and got the correct number and his doctor had to call and go through some hoops, like informing them that DC was allergic/bad side affects for every drug they were suggesting to replace. They granted one year. So, we have to go through it all again next year.

You realize that the employer decides which "plan" within UHC right? We have an awesome UHC plan that we've necer had any issues with. But the employer pays $$$$ for it. Not all plans with the same company are the same.

Anonymous wrote:This is pretty common with many health insurance companies. I have Kaiser and certain meds are out-of-pocket. Try and see if you can get the doc to report to the insurance company that all other options were tried and this is the only medicine that will work for the child.

No it is not common. United and Kaiser are hug offenders when it comes to providing sub-optimal coverage and care.

Could someone please help me find the link to the appeals process?? Have looked all over United Healthcare. I am stumped. I can only find medicare info. But I need just regular appeals. Focalin is the safest drug with the least side effects and we finally got here after a lot of face twitching and other queer symptoms with others.

We had the same problem with Blue Cross/Blue Shield last year. They said our plan no longer covered Focalin. I agree that it's a lot of BS. Like many other's, we had tried many different ADHD meds over the years and Focalin was the only one that worked for my child without a lot of bad side effects. Fortunately, we were able to get it approved through a Prior Authorization which required that our doctor write a letter that it was medically necessary for our child and that other medications had been tried without success. it's incredibly frustrating for parents to have to go through this. Good luck.