PCOS Messages for September, 2001: Re: Claim for Vaniqa denied

Re: Claim for Vaniqa denied

From: Celeste (anonymous@obgyn.net)
Wed, 5 Sep 2001 14:31:08 -0500 (CDT)

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At Wed, 5 Sep 2001, Anne wrote: >

I have no experience with your pharmacy provider, but think an appeal would be worth it.

Most of us find that our insurance won't cover Vaniqa because it is considered a "lifestyle" drug. They use this clause to not pay for birth control pills or fertility drugs, saying that these medications (though they are prescription) "are not necessary for life".

Of course we need them because our bodies don't work right through NO FAULT OF OUR OWN, and IMHO a lifestyle is something that a person has *chosen*, and choice is not available to us.

It sometimes make me feel like why bother having advances if they are not covered so that we can have them? Then I think it's hurtful of the company to advertise it so heavily when it is out of my reach. Sometimes I think, oh well, Minoxidil and yeast infection cream used to be prescription but now you can just buy them at a somewhat discounted price OTC. Maybe that will happen for Vaniqa. In the meantime I CHOOSE not to spend the money on it, when I can have two months at the gym for the price of one tube of the stuff.

>I am fuming! I just received a letter from the Paychex, denying my claim
>for Vaniqa. As an optional work benefit, I could sign up for a Flexible
>Spending Account, described as a “budgeting tool that helps take care of
>expenses not covered by a comprehensive benefit plan such as day care,
>dental and optical care deductibles, co-pays, and prescription drugs”.
>The employees' premium contributions are automatically deducted from
>their salaries before taxes are taken out, so in the end you end up
>saving over 30%.
>
>They denied my claim under IRS publication 502, which clearly states:
>“You can include in medical expenses amounts you pay for prescribed
>medicines and drugs. A prescribed drug is one that requires a
>prescription by a doctor for its use by an individual. You can also
>include amounts you pay for insulin. Except for insulin, you cannot
>include in medical expenses amounts you pay for a drug that is not
>prescribed. “
>
>Vaniqa is a prescription medicine! They pay for day care and massages,
>for God's sake! This is so unfair! What can I do?

--
Celeste

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