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Getting Insurance to Cover a Stimulant and Strattera

Q:

"My 13-year-old is doing well on the stimulant-Strattera combination his doctor prescribed, but my insurance company is unwilling to pay for both meds. Any advice?"

A:

Appeal the decision (consult your insurer’s benefits handbook or its website to find out how). The doctor may be required to justify prescribing two meds, either in writing or by telephone, so give him a heads-up. Most insurance companies will respond to your appeal quickly. If your appeal is rejected, move up the chain at the company and ask about the next step. Don’t let your insurance company practice medicine. Your physician should be the one to decide which medications your son should take.

Larry Silver, M.D., is the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities. He is also a clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C.

1 Comments:

  • Posted by Peggy - Nov 12 2007 @ 2:42 PM
    Insurance and medication coverage
    I recently experienced the situation where insurance would only cover 1 not 2 meds I require. I appealed and insisted that my doctor could not change diagnosis and treatment as that would be a purposeful misdiagnosis and is against the law. I mentioned that refusing to pay for both meds would prompt my "disability" to come forward with negative effects creating havoc and limiting my ability to function properly. After: I received not one but 3 phone calls saying meds would be approved for payment. This not only helped me but my doctor told me others in her care too were approved because of the action I did. Speak up and make yourself count.
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