22 Sep, 2018 → by ClaimboUser514510
Prior auth denied due to assumptions
1
3 years ago I had frozen shoulder in my left arm non dominant. Painful beyond belief. Now I have it in my right shoulder and it’s double the pain because it’s my dominant side. Previously dicoflonex gel took the edge off so I asked for it again. I had HP last time and had no problems they didn’t require a prior auth. BCBS does apparently because it’s part of their step therapy program. My MD submitted the PA and BCBS denied it. When I asked why they said because I had not been trying oral nsaids. Seriously? Really? You know this how? Because nobody asked me. For the love of my sanity I wanted to go off the deep end but I said funny I have a bottle of ibuprofen and Aleve sitting right next to me. Had the crap worked I wouldn’t ask for the topical gel. It’s 70.00 a tube out of pocket this condition can last up to 2 years. MdD resubmitted with notes letting them know I have been taking orals. Still denied. Lord hold me back. They won’t pay for this gel but would rather have me go I and have a surgical procedure done? Really? BCBS is like Medicare too big for their britches and a bully corporation. I can’t stand having them as my insurance carrier nor can I stand having to deal with them at work.