Trying to navigate the cold, confusing health insurance maze

If you are young and on medication, and the approval of your peers is your life nutrient, then an unsightly side-effect — in this case, drooling — is unacceptable. Fortunately, there is a common and generic treatment; according to GoodRX, it costs $23 a month. I phoned it into the patient’s pharmacy.

A day later, the pharmacy called: Insurance had rejected the claim. I called the insurance line and spoke to a pleasant representative. She explained that my patient would need to try three other medications for peptic ulcer disease first.

The patient didn’t have peptic ulcer disease; she had schizophrenia. Salivation was a side-effect of the only drug that had helped her. I filled out a Prior Authorization form with details.Read the entire article on The Boston Globe