Re: Claim for Vaniqa denied
From: Anne (anonymous@obgyn.net)
Wed, 5 Sep 2001 17:19:34 -0500 (CDT)
Thanks everyone for replying. You guys are great!
Actually, Celeste, I know that my insurance won't pay for Vaniqa, I
didn't even go there. I was talking about a flexible spending account,
where my OWN money is being witheld every pay period for the purpose of
covering for medical expenses that the insurance doesn't cover
(prescription, co-pay, etc.). This way, I pay my expenses with my OWN
money before taxes, thus saving around 30%. I use the cream because
it's great for me, I was actually able to go on vacation for almost two
weeks without worring about waxing, etc.
I actually called Paychex this morning, someone was supposed to call me
back - no one did; called again just now, and the customer serveice
representative only told me that the claim was denied, without being
able to explain why.
At Wed, 5 Sep 2001, Celeste wrote:
>
>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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