Insurance wont cover my pump anymore.

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Insurance wont cover my pump anymore.

Postby allisonaltman » Apr 30, 2011 6:08 pm

I live in Texas and have molina healthcare. I was admitted into the hospital twice in my first trimesterfor severe dehydration then i got on oral zofran and i went back again for 6 days because it didnt work. I was then put on the zofran pump and it works great I only throw up once or twice a day now. The insurance company after me having the pump for two weeks has now said its no longer medically necesary. My doctor is going to admit me to the hospital when I start vomiting again because the dehydration has cause me kidney damage and if I get severly dehydrated again my kidneys could fail. How is it legal for them to disagree with my doctor and tell me they wont pay for my medicine?
:) 16 weeks :)
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Postby nekorachan » Apr 30, 2011 6:29 pm

call the insurance company and speak with someone and tell them the situation...ask if there is any way you could be approved to stay on the pump - either that or they can spend more money when you end up back in the hospital. i was on medicaid when pg. with Jared and i was only allowed 12 zofran per month - unless my doc would fill out a certain piece of paperwork after which if approved i could get up to 30 zofran. talk to your doctor also and see if they know of a way to help you stay on the pump.
~Shelley
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Jared Constantine - 12/29/10

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Postby allisonaltman » Apr 30, 2011 6:43 pm

Ya her office director called and tried to convince them but they just dont agree. I went through the appeals process and sent them more medical records and still nothing.
:) 16 weeks :)
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Postby garnet » Apr 30, 2011 7:42 pm

Wow thats awful. Do you qualify for medicaid? At least here (Kansas), as long as you try to use your primary insurance first, they will cover what the insurance refuses. I think it's a little easier to be approved when you're pregnant too, although I don't know about Texas.

I hope you find a way to work this out. :?
garnet - mom to Nathaniel. Hg from week 7 - 36 (birth).
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Postby allisonaltman » May 03, 2011 7:05 pm

Actually molina is apart of medicaid. I was in the hospital for three days I got released today but I got my pump back so im happy:)
:) 16 weeks :)
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