Anybody Know Legalese?!?

John A. Quayle blueoval at SGI.NET
Thu Jan 13 14:41:21 MST 2000


Sender: owner-liberty-and-justice at mailbox.by.net
Reply-To: Liberty-and-Justice at mailbox.by.net

Hey folks, this just in from a friend. Any information on this as requested
by Mark would be appreciated! Thank you,
Patty Neill

****************************
Greetings all:

I'm sending this request out to a wide variety of resourceful and
knowledgable people in my address book, with the hopes that someone may
have the answer.

I am currently employed at Daman Products, and have been using Humana as a
health care provider.  I have been using Prilosec for acid-reflux disease
(excess stomach-acid production) for several years now.  Now my insurance
company is telling me that I am limited to only 120 capsules for the rest
of my life.  They will only grant exceptions if the doctor calls them and
fills out all these forms, etc, to override their decision.

The nurse at the clinic told me that what they are doing is illegal.  Does
anyone know if such is the case, and if so, what law makes it illegal?  I
was under the impression that no insurance company can deny medications if
a doctor prescribes them.  I need to know which law covers this issue, so I
can have some ammo when calling the insurance company.

My doctor refuses to call them, talk to them for 15 - 20 minutes answering
questions, and fill out all there silly forms, just to have the insurance
comany do what he has already decided is best for his patient (me).  I
don't blame him.  He doesn't have time to sit and answer a bunch of
intrusive, presumptuous questions.

Insurance companies are getting out of hand on this one.  This particular
one, acc. to the nurse, has even denied meds for cancer patients there at
the clinic.

Any help you can provide would be greatly appreciated.

Thanks,

Mark Pettifor



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