Re: Claim for Vaniqa denied
From: Anne (anonymous@obgyn.net)
Thu, 6 Sep 2001 15:40:30 -0500 (CDT)
I felt like sharing this with someone, but not with my colleagues…
The representative called back today, with an “explanation” for my claim
being denied (I had the IRS 502 handy). He read to me that unnecessary
cosmetic surgery - procedures such as face lifts, hair transplants, hair
removal (electrolysis), and liposuction – are not deductible. I
reminded him that this is a Prescription DRUG, not a surgical procedure,
and 509 does not have any exceptions re: prescription meds.
He than said “I guess they denied it under personal use items” and
started reading: “an item ordinarily used for personal, living, or
family purposes unless it is used primarily to prevent or alleviate a
physical or mental defect or illness. For example, the cost of a wig
purchased upon the advice of a physician for the mental health of a
patient who has lost all of his or her hair from disease can be included
with medical expenses. “ I laughed… I’m not buying a mask to cover my
face, I’m buying a medicine, available only by prescription. Would you
cover for a mask?
As if suddenly aware of the ridiculousness of his claims, he said he’d
have to look more into it and call me back.
I’ll Keep you posted
At Wed, 5 Sep 2001, Dona wrote:
>
>Hi Anne,
>Appearantly someone at Paychex is missinformed and thinks that you can
>get Vaniqa over the counter. If I were you I would call them and tell
>the claims processor there that Vaniqa is a controlled medication and is
>by RX only and not covered by your regular insurance and that is why you
>need to use your pre-tax dolloars to help with the cost as it is $40-60
>a tube!I would also get a letter from my Doctor to send to them stating
>that the Vaniqa is RX for facial hair do to a endocrine disorder and
>without it your mental well being will be in jepordy!My office stopped
>using Paychex because of there inefficiency.When you send the letter
>from the doc to them...make sure to send a COPY only as they have a
>tendancy to LOOSE letters...you may have to send it more than once. it
>is worth the fight!Also send a Copy of your RX if you have to...writing
>void on it of course.Good luck to you,Dona
>
>>At Wed, 5 Sep 2001, Anne wrote:
>>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?
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