Florida Blue Lied to Me About Drug Coverage

Jul 21, 2016

  1. DemandFairness

    DemandFairness New Member

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    Hello. I am a Lymes Patient in severe chronic pain and I have Florida Blue - BlueOptions 1424 All Copay plan. I was told I need a prior authorization for a pain med, and so I had my dr submit the authorization. I hear back and they say not enough information was submitted. So I have the dr submit urine screen, office notes, etc. I hear back saying the urine screen results are 6 months too old, and now I need to submit an appeal. The drs office is getting annoyed at this point and dont want to deal with it.

    I call Florida Blue back, and explained the situation - the lady on the phone tells me that if I submit a new urine screen, it will be considered new information and have up to 30 days to submit it. I go to my dr, tell them that, then call Florida Blue back to tell them that my dr is submitting the new urine. The lady consults with the medical people at BCBS, and she says "sorry, you must now submit an appeal." So I explain how literally I had just called last week and I was told if I submitted new urine it would be considered new info and that I wouldnt have to appeal it.

    This kind of thing has happened to me SO many times with BCBS - I'm being jerked around and I dont like it, especially being in chronic pain where I have barely any energy to take my one math class or even exist. Anyways, how do I even do a drug appeal at Florida Blue? Is there a way around this based on what the first lady told me? Can I get an agent to help me deal with this sort of thing?