Infantreflux.org | Meds change, insurance prob, mom in tears

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April 19, 2006 at 8:38 pm #6422

Anonymous
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well, we got to the bottom of the food allergies and Michael and I are off soy and dairy. His meds got increased to 30 mgs daily…. things were going well, then the insurance company hit!

After a long two week battle with my GI, my compounding pharmacist, and myself against United Healthcare, I have found that they will not cover Michaels Prevacid because he is “over 1 year of age” and “there are other meds available”. They only cover non FDA approved for pediatrics, meds. I even had my GI doctor speak with them personally to get a “prior authorization”…it was declined. So now I have him on Prilosec OTC crushing half a pill twice daily over applesauce and praying that it will work. Does anyone know how long this will take to kick in? Does it work as well as the prevacid?

Here is the kicker, they would cover the solutabs but since he is allergic to dairy he can’t take them. They cover the packets but he spits the out and the medicine ends up on his belly instead of in it… so why the @#$@W%@&*$& won’t they cover the capsules. Now they tell me, send in a letter to the appeals department and we will get back to you in 30 days with an answer but until then you need to work something out. I am about to pull my hair out. Not to mention that Michael hasn’t had a full dose of medicine in a few days and now we have switched meds. It has taken me 2 hours to get him to sleep, when normally he goes to sleep on his own and happy. He cried for two hours, everytime he refluxed and then ended up with the hiccups something terrible. Now I am going to cry!

Laura, I tried to find your link for going to the top of the insurance companies but couldn’t, if you would post it for me again I would appreciate it.

Sorry this is long and doesn’t make much sense… I am having a hard time finding my happy place today. Any help would be much appreciated… TIA

April 19, 2006 at 9:02 pm #6424

hellbennt
Keymaster

Going to the Top (fighting insurance & more): https://www.infantreflux.org/forum/forum_posts.asp?TID=2607&a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;a mp;KW=going

April 19, 2006 at 9:10 pm #6428

Anonymous
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I really am so sorry that you are going through such a hard time. I don’t have any advice. I just know what you’re going through. I hope that things get sorted out with the insurance company soon. I do find it odd that they would cover the solutabs but not the capsules (aren’t the solutabs more expensive?). Anyhow, I hope things improve for you and Michael soon.

April 20, 2006 at 9:24 am #6448

Anonymous
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I know how you feel, my little guy has medicaid and they will only cover the prevacid packets, which he can’t take b/c for some reason they make his reflux worse..so I just pay out of pocket for the soltabs….

April 20, 2006 at 11:34 am #6462

Anonymous
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This is just another reason why i hate insurance companies. They just really don’t make sense sometimes. I hope that prilosec works well!

April 20, 2006 at 1:36 pm #6472

Anonymous
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Can you maybe try the packets again and mix the medicine with a little baby cereal and give it to him by spoon? My son hates medicines and spits them all out. I’ve found that the only way I can give him meds is to put the dose in a little medicine cup and then add a little baby cereal and feed it to him by spoon. It’s harder to spit it out when it is thickened with the cereal, and if it does come out of the mouth it’s easy to scoop it back up with the spoon and put it back in his mouth. When they spit out a liquid dose it’s almost impossible to get it all back in the mouth, but with the cereal it’s so much easier. I’ve had great success with this method.

April 20, 2006 at 3:40 pm #6475

Anonymous
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Melissa,

You should know that the way you are giving him the Prilosec definitely will NOT work. The OTC tablets have an enteric coating that protects the drug inside from coming in contact with the acid in the stomach, and if you crush them then this will allow the drug to be degraded and destroyed by the acid.

The only forms of PPI that we recommend for infants and small children who cannot swallow pills are: Zegerid Powder for Oral Suspension (omeprazole), Prilosec Capsules (omeprazole) sprinkled over apple sauce, Prevacid (lansoprazole) Solutabs, Prevacid Capsules, or Prevacid powder packets. Out of these, the easiest one to use for infants and small kids is Zegerid, since it is a stable true liquid suspension and can be given without regard to mealtime (unlike all the other kinds I mentioned).

If you have any more questions, please email me: andrewsjj@health.missouri.edu

April 20, 2006 at 8:42 pm #6499

Anonymous
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well, as Joel has said I read on the Prilosec site that the crushing method of the Prilosec won’t work, so I have obviously abandoned that method. I have sent a letter to both the appeals department and faxed a letter to the CEO of United Health Care so I am hoping that I get some answers from those avenues. Right now I am paying for the prevacid capsules out of pocket however I have gone online and into canada for my prescription. http://www.jandrugs.com sells Prevacid 15 mg capsules at 161.00 for 84 instead of Walgreens which is 393.00 for 60. I am not happy about taking my business out of the US however I can’t afford the medicine here and I won’t have my baby in pain. jandrugs makes things very easy and all the forms are online to print out and fax in. I will keep you posted about United. Thanks for all the advice

April 23, 2006 at 7:23 pm #6647

Anonymous
Inactive

Hi Liss, we have United Healthcare too and I don’t know if this is still the case but we could not get them to cover the 15 mg capsules either but go figure they would cover the 30 mg ones!!! Apparantely, no other drug is comparable at that dose level so they have to cover it. This is also the reason they must cover the solutabs and suspension packets because no other maker has a similiar product. We did end up switching to solutabs before Seth was one so I don’t know if the 30 mg capsules would have been an issue after that but I don’t think so. Maybe your dr. could just prescribe you the 30 mg and you could split them?? Good luck. I know what I pain this is….

April 24, 2006 at 6:19 pm #6732

Anonymous
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Melissa,

So sorry to hear you are having such troubles. My Ped GI doc prescribed Zegerid for our little Max and the insurance company balked at it. My doc sent them a letter saying that if they refused to fill it as written, they would be interfering with his ability to care for his patient properly and that it could result in a lawsuit. Needless to say, the insurance company approved it immediately and I have had no problems since. I live in California where the laws protect the patients, so it may have to do with your state laws. It may be worth looking in to.

April 27, 2006 at 11:27 am #6984

Anonymous
Inactive

maxsmommy wrote:

Melissa,

So sorry to hear you are having such troubles. My Ped GI doc prescribed Zegerid for our little Max and the insurance company balked at it. My doc sent them a letter saying that if they refused to fill it as written, they would be interfering with his ability to care for his patient properly and that it could result in a lawsuit. Needless to say, the insurance company approved it immediately and I have had no problems since. I live in California where the laws protect the patients, so it may have to do with your state laws. It may be worth looking in to.

now that’s a GREAT doc!

the tip for trying the 30mg might work. fingers crossed for you!

April 28, 2006 at 9:23 pm #7141

Anonymous
Inactive

Hi Everyone,

Well the battle continues. I sent the letter to the CEO and received a call earlier this week from the consumer relation representative who apparently is taking our case in her own hands. I have resent through all of my avenues (dr, pharmacist, allergist) all of Michael’s information and the documentation to back up my statements in the letter. She told me she will be going over everything personally and will let me know in 10 business days.

THe good news is they did cover the couple of prescriptions we tried instead of the capsules so at least I don’t have to pay for those!

I would also like to say that I WANT MAX’S DOCTOR!!!!! Thanks also for the heads up about the 30 mg capsules. If this doesn’t work and Martha from United calls me back with the answer I will talk to her about that next! Thank you all for your help and advice! The reflux it starting to calm down a little now that we are back on the right meds, however Michael is working on 2 molars at once! No sleep in this house! Hopefully they poke through soon!
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