Psycho-Babble Medication | about biological treatments | Framed
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Re: Effexor -- insurance co. doesn't like dosage

Posted by ksvt on September 27, 2000, at 20:02:11

In reply to Effexor -- insurance co. doesn't like dosage, posted by shar on September 27, 2000, at 14:08:56

> When I go to get my Effexor XR refilled, the ins co. won't pay because they say my dosage is too high. I'm on 300 mg. per day which is up there, but not excessive. So, I now always tell the pharmacy they will have to call the ins. co. and get an override so they'll pay.
> The first time it happened, the Effexor was going to be $180. It really made me think about people without insurance, or those with crappy policies who end up suffering because some business person(s) decide to 2nd guess the doc.
> This is not an HMO. It is good old Blue Cross/Blue Shield here in Texas for State gov. employees.
> Another of their antics was AFTER the sign up period was over, they DOUBLED the deductible for MH services (counseling type things). From $250 to $500. So, I could get IN-PATIENT care for $1,000 a day, for up to ??60 days I think. But, to get $200/mo for counseling....forget it.
> And, this is a rip-off for my counselor too. I really regret that because she will lower my fee when I have to pay it all. We both deserve better.
Shar - I'm fortunate to live in a state which passed a law a few years ago disallowing mental health caps unless they were similar to caps for other medical services. However, in all of the time since passage of the law, blue cross blue shield has never changed its explanation of benefits, so if you're not a saavy consumer, you'd still think that the mental health care coverage limitations were still in place. When new enrollment periods came around after passage of the legislation, they sent out info to their business subscribers which woefully misrepresented the differences between a managed care option and an unmanaged care option. If you didn't go out of your way to respond very quickly, you were automatically defaulted into managed care. It's great that they even offered an unmanaged care option to some business groups, but my guess is that the vast majority ended up in managed care without even realizing that they had a real choice. Getting back to the thrust of this thread however, it's not like these ADs are all generic. Everyone reacts so idiosyncratically. The hmo certainly shouldn't be deciding what drug will work for you. ksvt
> Ah, that felt good to get off my chest.
> Noa, thanks for those web sites. I am going to write to them.
> Shar




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