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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by curtm on September 3, 2006, at 7:18:26
Provigil is intended for use with narcolepsy and sleep disorders, but has shown to have some effect treating symptoms of depression. My pdoc prescribed it to me due to depression which apparently is causing some sleepiness and fatigue, among other symptoms.
My insurance denied coverage of the prescription I assume due to the *off-use* of the medicine. If that is the case, what are the chances that in the future this medicine is reviewed and classed as a treatment for depression and insurance companies will cover it? Does anyone know if this is common? If so, what normally causes this to take place? Should I call or write someone to voice my opinion?
If they change their policy, I assume I will have to keep checking with them to make sure if it will be covered or not.
On another note, What if I go to my family physician and explain this to him...maybe I can get him to prescribe it to me under the intentional use and could get it covered by my insurance?
Curt
Posted by bassman on September 3, 2006, at 8:56:39
In reply to Provigil and insurance coverage, posted by curtm on September 3, 2006, at 7:18:26
What's really odd is that if you look on remedyfind.com, it it number 1 rated treatment for depression by users! Maybe it's off-label, but evidentally it works very well for some people. I wonder if it could be prescribed for "daytime sleepiness"...I seem to have seen that somewhere. Maybe your pdoc/GP could give you some samples to see if it works for you first (?).
Posted by Racer on September 3, 2006, at 9:45:24
In reply to Provigil and insurance coverage, posted by curtm on September 3, 2006, at 7:18:26
Chances are, your pdoc could help you get coverage by appealing to your insurance carrier. Now, I'm going to be brief, because I can get very, very incivil when it comes to insurance companies. Forgive me if I don't sound friendly -- it's NOT directed at you...
Anyway, appeal this decision. Right now, the insurance company is prescribing medication to you, in effect, and that's not what you want. Find out what their appeals process is, and use it to petition for Provigil. You'll need a letter from your pdoc, which I'm sure he/she's done before.
I hope you won't let them get away with this. And that it's a short appeal, and they pay happily. Good luck.
Posted by Phillipa on September 3, 2006, at 12:10:20
In reply to Re: Provigil and insurance coverage » curtm, posted by Racer on September 3, 2006, at 9:45:24
Curtm I hope you win. Love Phillipa
Posted by gardenergirl on September 3, 2006, at 14:30:02
In reply to Re: Provigil and insurance coverage » curtm, posted by Racer on September 3, 2006, at 9:45:24
I bet that the makers of Provigil have a sample letter already written for doc's to use for appeals, assuming that would be legal for them to do.
When I ordered my lightbox (dang, forgot to use it today!), I downloaded an insurance appeal letter for my doc to sign. They still denied it, but at least I had something to use to try to appeal.
Good luck. I'm fortuntate that despite my pdoc assuring me that my insurance would not cover it, I've had no problems with coverage.
gg
Posted by AuntieMel on September 5, 2006, at 8:41:31
In reply to Provigil and insurance coverage, posted by curtm on September 3, 2006, at 7:18:26
My insurance covered it. But it was worded to use "as needed" for daytime sleepiness due to insomnia.
As a matter of fact, that's also how I had to word it to my doctor in order to get him to prescribe it....
It's a wonderful med. I switched from it to Adderall and I'm not sure it was a good switch.
This is the end of the thread.
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