Lee Ann asked me to do a short post about Luke’s recent TEFRA filings and how things are moving (or not) on that front.
I sent in a substantial check to cover three months’ TEFRA premiums. Of course, I’ve already received an invoice as if I only paid for one month. I guess I’ll deal with that this weekend. Anyway, we thought his medicines would finally be covered; anything insurance didn’t pay, TEFRA should pay in full. Guess what? It’s not so.
Medications have to be on the “approved” list, and of course, Luke’s medicine was not. In their infinite wisdom, the mighty federal government has decided that the acid reflux medicine he is on can only be paid for if the person was first on another particular one for 2 months. So, after fighting reflux for practically 19 months and finally getting it under control, the government is forcing Luke on to a medicine we and his doctor KNOW will not work and will probably cause him discomfort for 60 long days and nights.
Fortunately, Luke is a sweet kid with a good disposition, and he’ll get through it just fine.
Lee Ann
Nicholas Stehle
Grief! That’s just brilliant of them. Makes me wonder if they have some kind of interest in that particular drug company. Probably not, probably just some kind of stupid rule someone dreamed up to keep from having to pay any benefits.
Hang in there!
can you put him on it for pretend? and continue to give him the other?
I wish.. I thought about it but I would then have to pay for the meds that work at full price which is nearly what a pay monthly to be apart of the program. Does that make sense?
We are currently doing research into some natural remedies for Lilys reflux…I am praying it works. We ahve tried everything and we are at the end of our rope! The medicine she is on is the ONLY thing that works but it cost us so much money! I completely understand what you guys are going through and am praying that you find a solution!