LouiseKl Date Rated: 8/2/2015 10:40:04 PM
I chose this plan because Medicare's drug finder indicated it would be the best match for me given the few medications I take. I switched from another plan, which in hindsight was much easier to deal with. My doctor prescribed a medication I have taken for years. The drug Finder indicated it would be covered. CIGNA health spring refused to fill the prescription because they said it needed prior authorization. Prior authorization was not indicated on the drug finder when I chose CIGNA. My doctor started calling in this prescription for me in April. After patiently waiting and checking with CIGNA, they told me in May they had not received the prescription. This process was repeated three times, until we got to July, and I sat in my doctors office to be certain the prescription was called in. After a few days, this prescription was denied because for the first time CIGNA informed my doctor and me that prior authorization was needed. Apparently this had held up the prior called in prescriptions, or else they were somehow lost in the system. I am convinced that my doctor did call the prescription in starting in April. My doctor then spoke with CIGNA's coverage determination department, and went over the reasons why this medication was being prescribed, noting that I and my doctor were aware of the risks, and that other so-called "safer" alternatives were not appropriate or had been tried in the past by me and were not tolerated. The prescription was denied. My doctor filed an appeal for me. I followed up and called both CIGNA's coverage determination department and the appeal department. The coverage determination department simply read me the paragraph in their standard form, stating that the medication prescribed was high risk because of my age and that I had not tried "safer" alternatives. My doctor and I are well aware that in my case this is the best and safest medication for me. About five medications, which I've already had reactions to in the past, would be required to treat my symptoms were I to change medications. The coverage determination representative could not tell me specifically why authorization was denied. They insisted, by reading the "canned" paragraph, that I should have tried a couple other medications, which quite obviously had nothing to do with my individual symptoms. They did not seem to take into account any of the information which my doctor provided. Upon appeal, my medication seems to finally be approved, but this has required hours of work on my part and my doctors part. This is not fair as the situation was quite straightforward in the first place. No competent person seems to have paid any attention the information my doctor provided. Further, an earlier one time medication prescribed for me last February was denied, and finally approved a month later upon appeal. I had had to pay cash for the medication myself, as I was very ill and desperately needed the medication. I had to jump through many hoops, including filling out forms and sending CIGNA documentation that I paid for the medication. It is now August, and I still have not been reimbursed for the medication. Because of the way CIGNA dated their review, it looks like the first round of medication I paid for may not even eventually be reimbursed. So, I am paying much more money for this plan, and I'm extremely unhappy with the red tape and the lack of reimbursement. In my case, it seems that CIGNA has a plan of simply denying all requests and requiring one to go on to the appeal phase, creating work for the patient and the doctor. The customer service representatives in the coverage determination department do not seem competent to me or to my doctor.