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  #1  
Old 09-07-2003, 05:00 AM
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My son recently had to withdraw from college becuase he was sleeping 18-20 hours a day and unable to keep up with his studies. He is 19 years old. He was diagnosed with severe sleep apnea in May, which has slightly alleviated the problem of sleepiness, but not well enough. He was put through a second more thorough sleep study last week, and diagnosed with narcolepsy, and prescribed Provigil. We are now in a battle with the insurance company, which refuses to pay for the medication. Does anybody have any suggestions on how to go about trying to get the medications paid for?
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  #2  
Old 09-12-2003, 05:00 AM
Dana
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Default provigil assistance

I love provigil. It has saved me!! I have a form of narcolepse which caused all kinds of problems for me while I was in college. If you go to the provigil website,you can apply for assistance. I believe it is www.provigil.com<br><br>Good Luck
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  #3  
Old 10-08-2003, 05:00 AM
di
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Default insurance red tape

In my case I have not had the diagnosis of Narcolepsy. I have Epilepsy and a sleep disorder, NOS (still undergoing studies and tests). In the mean time, I experienced excessive day time sleepiness and fought to keep from falling asleep at the wheel (my job requires alot of travel).<br> Initially my insurance would not cover Provigil until my doctor had tried other stimulates (adhd med i.e. adderall, concerta, etc.)and reported undesirable side effects. After the first attempt and while waiting my insurance co. reply to my doctor's letter, she provided me with free samples from her office.<br>Prior to running the gambit of other meds the insurnce company wanted my doctor to try first, my employer's open enrollment rolled around and I changed my insurance provider (which approved the prescription without question). MCO's or HMO's will give you a hassle when it comes to many meds and tests. A PPO has a higher premium rate, but, is worth it in the end. <br>Good Luck.
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  #4  
Old 10-18-2003, 05:00 AM
Nancy
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Your sons medical doctor can write your insurance carrier a letter explaining the need of this particular medication. My doctor did and it is being covered under my health insurance. Thank goodness.<br>Good luck to your son. He is far too young to be going through this problem.<br>
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  #5  
Old 10-18-2003, 05:00 AM
Nancy
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Your sons medical doctor can write your insurance carrier a letter explaining the need of this particular medication. My doctor did and it is being covered under my health insurance. Thank goodness.<br>Good luck to your son. He is far too young to be going through this problem.<br>
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  #6  
Old 10-18-2003, 05:00 AM
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Find out if your insurance plan is "self funded" by your employer. If so, this means that your employer has the ability to make exceptions and pay for this medication. Ask your insurance company if this medication can be preauthorized for any future coverage. Keep in mind that medications must be medically necessary and your doctor may need to supply proof of this. Also, most insurance plans only covers dependent children until their 19th birthday unless they are an actively enrolled full time student.However even this restriction could be over ridden by your employer, if the plan is self funded. If your plan is fully insured check for state mandates regarding this medical condition,and or this medication that may require the insurance company to pay for it. Also if it is a fully insured plan there are some states that do not require a dependent child to be a full time student to maintain coverage usually up to their 23rd birthday, check with your insurance company.
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  #7  
Old 09-26-2005, 05:00 AM
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You can have your Dr. fax a letter to the insurance company explaining why your son needs this particular medication. This usually works fine. If not email me and I will give you further assistance. Good luck and never give up.
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  #8  
Old 09-26-2005, 05:00 AM
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Default Narcolepsy

My husband was diagnosed with narcolepsy. We tried adderall and it made him extremely violent and short tempered. Ritalin made him very jittery and he had no appetite. Provigil seems to be working the best of all three drugs. Hope this information helps someone. We also had to get a letter written to our insurance company by his Dr. to cover the provigil.
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  #9  
Old 12-02-2005, 06:00 AM
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Default provigil/insurance

I take provigil for narcolepsy. My insurance cmpany requires my neurologist to fill out a pre-authorization form each calendar year. I take it for narcolepsy. I then get this med covered for enough refills for the entire year as long as my neurologist validates a reason and responds with the pre-auth form. I have not had any problems. I do have a $15 co-pay.
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  #10  
Old 12-02-2005, 06:00 AM
Alex
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Default coverage

My insurance, Aetna has several plans available at enrollment every year. I chose Network Choice and am covered for a 90day supply from Aetna RX online for only $20.00. If you don't have this option, Methylphenidate(Ritalin) or Amphetamine (Adderall) are very similar in action, but a fraction of the price. The only issue is high potential for abuse, especially with a college student. Maybe giving your son a weeks dose at a time could help prevent any possible issues. Good Luck
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