Insurance - what they will and won't cover related to GERD?

Hi all....

Questions on how your insurance deals with some GERD related medications and procedures...and do you want to bang your head against the wall??

I took prevacid for years and went to get a refill and all the of the sudden I had to get "approval" from my insurance to get the prescription refilled.
Then I switched to Zegerid, they wanted approval too before they would fill the script. I'm still waiting, it's been over two weeks since the paperwork was submitted, for official insurance approval on the prescription. In the meantime I HAD to get it filled and pay $140 for 30 pills. Grrrr..

Now I'm having a fundo on the 29th and I called my insurance to make sure I didn't need to be pre-approved or all that jazz and they said "nope". So now I'm wondering if after I have the surgery they're going to come back and say "oh, btw that's considered elective surgery and we won't cover it". The surgeon's office should have checked with my insurance too, right? I mean they want to get paid so I would think they want to make sure my insurance is going to cover it. I'm getting anxious about my surgery so now I'm getting paranoid that I've over looked something....I can't help it!! They didn't list the fundo as "elective" in my insurance book.

Maybe I just need a Valium.....

Doghouse,

The surgeon's office should have contacted your insurance company regarding your procedure by now - after all your surgery is tomorrow. Give a call to them and confirm that your insurance company OK'd the surgery. Better that you go into surgery feeling without the anxiety of insurance hanging over your head.

As to the prescription filling problem - 2 weeks a long time to wait. I'd keep hounding your doctor's staff and then contact the insurance company yourself to ensure your doctor sent the proper forms completed to their specification. Sometimes there can be a holdup if the wrong form is submitted or if one item on the form is left blank. That happened to me - the doctor submitted what he thought was the proper form, but it was an older version and the insurance company never bothered to contact the doctor's office to ask for a new form to be faxed. Once I got involved, things moved much quicker - like the next day I had my prescription.

I'll be thinking of you tomorrow..........good luck.

The doc's office and hospital has confirmed with my insurance company that all is well. I guess I had pre surgery jitters and had to panic about something. Thanks for all of the support!