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My Medication was Denied by Insurance. Now What?



Has anyone else noticed insurance companies are denying medications more often these days? Keystone First just completely denied a medication I have been using for years, even though I failed on multiple approved medications.


I have inflammatory rosacea. It is an auto-immune condition that will not go away on its own. Flares come with disfiguring lymphedema, too. I work in the wellness industry. Looking healthy is everything.


I've been using this medication for three years. So imagine how shocked I was when I was informed that it is no longer covered.


This can be incredibly stressful, especially when a medication is crucial to your health.


Know that you have the right to appeal an insurance denial. Even if you think it will be denied again, please go through the process anyway. It may be approved, but even if it is not- the federal government will have data about your denial. Data that one day may eventually be used to pressure those with these contracts to cover more.


Everything you need to file an appeal is included in this article.


Medication Denied is the Beginning, Not The End


They're banking on the fact you probably won't do the work. Do the work. Appealing a denial can get you the medication your doctor prescribed. Unfortunately, you have to be proactive when managing health. Even when you are exhausted from a chronic condition.


Some situations are emergent. Like I don't have another month to wait around while I lose work and risk disfiguring scaling and scars. Dear US government: I had to cure my rosacea with horse ivermectin and large doses of vitamin C.


Because my highly sought-after Dermatologist who specializes in my condition can no longer prescribe me FDA-approved medication that I can afford to pay for out-of-pocket, she's been reduced to doling out the same advice as the Q Anon Shamen.

I am disabled and have multiple chronic health conditions, but if I want to look socially acceptable enough to remain employed and not have a blistering forever rash on my face, I have to use horse medicine from a feed store now. Cool. Cool cool cool. Welcome to America in 2024.


My doctor urged me to write this blog post. And tell everyone to write to their insurance companies. I bet they think nobody will go through the entire process.


You will. I am here to make sure you get that medicine. I'm going to walk you through it.


I even made you a free template so you only have to fill in a few things and then find the email address to send it!


Start here:


Insurance Appeal
.pdf
Download PDF • 45KB


They Denied Me Again. It's Over, Right?

Not even close. An internal appeal denial doesn't mean you have to give up on getting coverage for your treatment.


Here's what to do next:





Request an external review: An external reviewer, independent from your insurance company will re-evaluate your case. This process can be very successful. I included the appeal for the federal external review process.


Gather documents: Similar to your internal appeal, you'll likely need documents supporting your case, like a letter from your doctor. If you failed on other medications, you may wish to provide records of what dates those scripts were filled and the adverse effects you experienced. You can include photos of your symptoms and reactions, or evidence of lost work due to your condition not being properly treated.


Take Charge of Your Health

Don't be discouraged if your medication is denied at first. This template is a tool to help you fight for your health. When a medication is denied, remember the first step is to ask your doctor to write a letter of medical necessity for you. Then come here to draft your letter of appeal and email it quickly before you forget!


If it is denied, come on back and file a federal appeal online.


If this seems daunting, ask for support filling out the paperwork. Don't just let an insurance executive be in charge of your healthcare. Consider this part of the process. You must learn how to advocate for yourself. Nobody will do it for you.


Speak kindly to yourselves, it gets better.


Nicole








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