What is an insurance omnibudsman? And where do you find such a person? My doc said talk to the insurance omnibudsman about getting the remicade covered.
Maybe it was ombudsman?
I think they are the "go between" the insurance and doc's office. They should be able to tell your doc the exact wording needed to get your med covered. My insurance needed a "letter of necessity" - which is lame if you think about it because the doc wouldnt be prescribing it if he didnt think it was needed, but you gotta jump through their hoops.never heard that word before! Is the insurance carrier (you, hubby, etc) in a union? If so, contact the union for help. If not, look in the insurance books and find out who deals with the complaints.Oooooooooook. Kweenb..you are right. My bad in the spelling and hearing department today lol. Thanks for letting me know what the correct term is.
We have contacted the union and waiting for call backs. In the meantime we have also taken advantage of Danny's EAP he has thru work and they are going to hook us up with an ombudsman to help advocate for us and also help us navigate the insurance nightmare.
Yeah, letters of necessities are really ummm just lame. If it wasn't necessary why in the heck would I need to take it?? As my pcp put it to me today when I talked to him...it isn't like this is a toe fungus we are treating that doesn't have serious complications.
I think ombudsman is a military term, job or rank? A man who investigates complaints and mediates fair settlements, especially between aggrieved parties such as consumers or students and an institution or organization.I wished I knew someone like that, my husband works for a small family owned co. Insurance paid for meds until I went on Humira. Paid for that 2 months and insurance stopped all RA coverage. They were sorry they had made an eariler mistake by paying! Sounds like BS to me.They say RA is a questionable condition! I wished they could experince it & see how real it is! Any suggestions?
Write a letter of complaint, stating the facts, and include copies of all letters, paid and unpaid claims, etc. and address it to the Insurance Commissioner in your state. And send a copy of it to your insurance company. When complaints are registered with the Insurance Commissioner they must be answered promptly, by law.
This kind of thing just makes me so mad. If you aren't up to fighting this battle personally, find a family member who can do it for you, and then declare war!
My insurace pays for my RA visits but not for ANY medications.Now if I had cancer or lupus they would pay for MTX, but not for RA! Sounds stupid right! My husband's company underwrites their poilcy and we can't afford for him to lose his job, not that they would say that is why! Company only has about 75 employes. Thanks for your advice.I just don't know which way to turn.