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1491186 tn?1288405903

Follow up to Denied Pain Meds

Hey guys, I'd like to thank you all for your thoughtful and helpful replys to my post.

I finally found a dr. that I really like and is willing to help me. Today he wrote me for Opana 20mg bid  and Lryrica 50mg tib. I will call him on Wendnesday to tell him if I need to bump It up.  The only  bummer is that the my insurance co doesn't pay for Opana. My dr. gave me a discount card for $300 off, though  I'm not sure exactly how it works, I bought 20 pills ($170) and got $60 off.  The pharmasist, who is now my new best advocate even gave me the card back for next time.  

It's so awesome to be back on track. We also talked about deep brain stimulation. A little scary. Thanks again to those who took the time to reach out in my time of great pain and distress. Now I just have to watch out for the weight gain. Does counting calories help? Or does the Lyrica just make you add lbs?

Warmest regards,    
Best Answer
82861 tn?1333453911
Peek is right about the appeal process.  (And Peek, you can tell Mr. Peek I said so! LOL!)  

Check your policy and follow the exact directions for an appeal.  Some of them only require a phone call for a first round, but you may need to followup in writing to make it official.  Certainly if it drags on, you'll need to go the certified letter route.  You may need your doctor to put something in writing that nothing else will work BUT Opana.  Most of the time, the insurance company will want you to at least try something cheaper for a month before they'll cover a drug that isn't on your plan.  

Don't take no for an answer right off the bat.  Get on the phone and work your way up the food chain until you find intelligent life - and try to keep your temper because it'll probably take a while.  Good luck and go get 'em!  :-)
5 Responses
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Avatar universal
I was described with lyrica by my GP for headaches ive been having for the last 4 weeks.
Ive already been on all kinds of medication but nothing worked.
So as a trial he put me on lyrica 50mg for two week trial.
                                      Stemetril
Helpful - 0
1491186 tn?1288405903
thanks, my dr. offiec is doing thier best to convince the ins. co to change thier decision.

Best regards,
Helpful - 0
172023 tn?1334672284
Yep.  First they have automatically denied me many med.  Then the phone call.  The reps are actually quite helpful (to me, anyway!) and gave me a "how to" for the exact process of written appeal.

The first written appeal has always worked.  Except for Celebrex.  They stubbornly refuse to approve it despite me having tried others first.  Oh, well.  They must want me on narcotics.  
Helpful - 0
172023 tn?1334672284
Have you tried appealing the denial of the Opana?  Nearly every time I've appealed, I've been able to get the denial reversed.  
Insurance companies hope that you'll go away with the first denial.  Contact them to find out exactly how to appeal.  Sometimes it's a simple matter to correct.

I just started Opana, and it's working well for me.

I'm on Neuontin, and the weight gain issues are the same as with Lyrica.  I'm not only hungry, I'm not really losing at all even though I'm being exceptionally careful with the calories.    
Helpful - 0
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317787 tn?1473358451
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