Don't take NO for an answer from Kaiser. My husband's insurer told him the basically same thing about
his GERD meds. "We won't cover aciphex because you can take Prilosec OTC now." No, he can't. It doesn't work. They made him go through a month of trying meds they were prepared to cover to prove they didn't work. His doctor had to make phone calls and write letters and all that fun stuff, but he eventually got his aciphex covered. Give Kaiser a call, and work your way up the food chain. Don't take the "customer service rep's" word for it. There's always a way through, you just have to take the time to find the right person. It also helps to get a copy of the full policy under which you're covered - not the quick reference guide that most of use. The devil is in the details, so search through the legalese in the policy to determine exactly how to challenge coverage of meds that aren't on their formulary. And document everything in writing. Even if you have a satisfactory phone conversation, back it up with letter declaring your understanding of the situation. Yeah, it's a royal pain, but if you can pull it off it won't be as big of a pain had you not tried.
