Insurance companies/Cipro

  1. I took my son to the doctor the other day for flu like symptoms. She prescribed cipro for him and told us to keep him home over the weekend. Well, when I went to the pharmacy to have this filled I was told that our insurance company requires that they "approve" cipro and since it was late Friday it would be impossible to get it approved. We ended up calling the Doc and getting the prescription changed. This really pee'd me off!!!! Who the heck do these insurance companies think they are?????? If a DOCTOR prescribes cipro....who are they to say that they have to APPROVE this prescription since they have not seen the patient, nor do they know what it is being given for??? HOW DARE THEY???? The insurance company is Coventry and they ARE going to get a call from me!!!

    Anyone else run into this??
  2. 9 Comments

  3. by   maikranz
    You could have paid for the prescription yourself, out-of-pocket.
  4. by   prmenrs
    I thought Cipro was not supposed to be used for kids. Actually you didn't say how old he was, so??

    It's VERY, VERY expensive, Maikranz, that's probably why they disapproved it in the 1st place.

    If something cheaper that has less side effects to worry about, and it will get the job done, take it! Save the Cipro for some God-awful thing later!!

    Hope your son is better soon!!
  5. by   canoehead
    The state is trying to discourage prophylactic treatment for people coming in with URTI symptoms who could also have the beginning of anthrax. They believe that by prescribing potentially thousands of times, over the flu season could create a resistant strain, and then we would all be up crap creek. The man I spoke to pointed out that they recommend 60d Rx for prophylaxis of confirmed exposures, and it is very likely that people taking a partial course and quitting would increase the speed of resistant strains forming.

    Perhaps the insurance company is screening with that in mind, they probably don't want to pay for a course of Cipro every time someone c/o fever and cough, where normally no antibiotics would be prescribed.

    I heard that the NY hospital where the employee died of anthrax is giving Cipro to everyone who worked, was admitted or was a visitor there for the past few weeks. If that isn't inviting resistant strains to grow I don't know what is. However they are probably fearful of suits.
  6. by   essarge
    My son is 16 years old. I understand that cipro should be "saved" for something that may happen later. My point was that the insurance company is not a medical doctor and if a persons medical doctor feels that cipro is indicated then who are they to second guess???? We still only pay $40.00 for that type of prescription, but it was the principal of the whole thing that really gets to me!!!
  7. by   Q.
    I can understand how insurance companies can really P a person off. At the clinic I work at, we get hundreds of requests from insurance companies to switch to approved formularies, ie switch to lipitor from pravachol, generic lisinopril to zestril or prinivil, etc. What the insurance companies are trying to do, in essense, is actually save the consumer money by containing costs. If biaxin or what have you is indicated for a URI and is less expensive, why not utilize that rather than more costly Cipro? Especially now when Bayer is trying to keep up with production. Although doxycycline is also effective at treating anthrax - especially for children.

    By encouraging lesser expensive treatments and Rx's, they are attempting to keep costs down which will in turn be reflected by how much you pay in premiums, ie lesser treatments and Rx's for all, lesser premium costs for all.
  8. by   essarge
    I just listened to the archived airing from the CDC on anthrax. It was very very interesting. It listed all of the signs and symptoms and correct dosage etc to be used for children (10-15mg PO q 12 hours-cipro or doxycycline) and 500mg BID for adults. This was listed as the preventative dose. If it is diagnosed, the dosages are different.

    They changed my son to cephalexin 500mg BID. Suzy, I understand that some insurance companies are trying to "contain" costs for the consumer, but with what we pay for this coverage, I don't feel that they should second guess Medical Doctor's decision.
  9. by   debbyed
    Our hospital recently switched insurance carriers to an nationwide highly recognized (Color coded) insurance company (FIgure it out yet?) We were told it was a much better program especially the Perscription part.

    The first time I went to get my routine Rx. filed (That I had been using the last 3 years for a chronic problem) not only did they question the medication but also the dosages and demanded the physician explain himself in writting. In the mean time they would only pay for what they felt was the appropriate dose.

    To make matters worse we were told to send 1 years worth of RX. to the Pharmacy type, warehouse type place and they would ship 3 months worth of medicines at a reduced amount. I have filled out their paper work, sent in my RX's TWICE and they still have never heard of me!!!! (My neighborhood pharmacist sent flowers when my Dad and Grandmother died.)

    Well I guess I should know by now when dealing with the medical profession just what a "Better Insurance Plan" really means....We charge you more, Charge your employer less, and than ignore you as long as possible.
  10. by   prmenrs
    In the ideal insurance world, we would all pay big bucks for coverage, never, ever, get sick (ditto for dependents), as the entire family walks out of the retirement party, get hit by the biggest bus the CEO can drive!!
  11. by   essarge
    Grrrrrr The insurance company and I are about to go around again!!!! My hubby who is diabetic, high blood pressure, high cholestoral, became ill the end of September. It came on suddenly with high fever, weakness, and generalized pain .... took him to the ER (per doctor) he was seen, put on a course of antibiotics and I was told to monitor him for BP, sugar, etc.

    So I open my mail the other day and what do I get from the insurance company???? A letter stating that because it basically wasn't a matter of life or death, they will not pay it!!!!!!!!! Geesh...the doc is the one that said to take him up there...who the H*** do they think they are???? I'm soooo aggravated with this company right now!!! And of course when you call you get a customer service "rep", who has noooooo medical training or backgroud whatsoever!!!