Denied a vacation over ride on my medication
Dec 4, 2012
Not sure what to do next, and hoping you can give me some advice. I currently am on Aetna insurance, but it is paid for by the government. I am also on ADAP. Unfortunately, the government often pays late, but within the grace period of the given 30 days. Normally this wouldn't be a problem, but it seems to have become one. The issue is that I am going out of state for a month, and the pharmacist recommended that I get a vacation over ride so I could get my medication early (before I go out of town). The pharmacist called Aetna and the vacation over ride was denied, I'm guessing because it looks like I am not always paying on time. I'm not sure what my next step is to get my medicine since I won't be able to get it at my regular pharmacy. Any suggestions?
Response from Mr. Chambers
Did Aetna give a reason for the denial? What are your appeal rights?
If your coverage comes through an employer, it's under a federal law that allows several levels of appeal, and also requires prompt answers when an expedited appeal is filed.
If your coverage is individual coverage, then it depends on the insurance laws in the state you live in. You may want to contact your state's Department of Insurance to see what rights you have and what help they can provide.
You with your pharmacist should appeal this denial. I'm somewhat surprised they denied what is usually a routine request.
Good luck, Jacques
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