Envisions RX give their members the prescription coverage and service they deserve ?

My name is xxxx.xxxx I wanted to ask If you have heard or learned anything about this new “Opioid Safety Form?”  It is required by my Medicare D (Envisions RX) for patients who need over 200 MMEs per day. From what I understand it will soon be required by all Medicare D companies. The form consists of 2 questions. What is the patients diagnosis and is the prescribing physician aware of the dangers of MMEs over 200 and does the physician agree that the patient needs this amount of narcotics. I find the form to be totally ridiculous as it does not require the doctor to sign it. The medical assistant or even the secretary who answers phone can fill out this form. 

My doctor did sign my form anyway and it got sent to my insurance company 6 times! Insurance denied ever receiving the form. My doctors office re-faxed the forms showing the date and time stamp that proved insurance company received it. 

I was so stressed out as my sister paid nearly $1500 so I could get my medicine and I owed her that money. In addition I would not of been able to get any other pain meds until the form was accepted. 

My doctors office received first faxed request from Envisions RX at 11:55 A.M. Friday Jan 12th. It stated they had 72 hours to respond! Fortunately my physician was still at the office and the form was completed and sent back before 1pm that same day. I received an automated message Monday night stating I was denied because of no response from my doctor. That was the beginning of 2 weeks of pure hell and over 15 hours of my time on the phone with my insurance company.  I find this to be a “set up” putting a time limit of 72 hours for a response and expecting the doctors office to respond over the weekend! Nobody is in the office over the weekend. I was fortunate that the Fax was seen before the office staff left for the weekend. 

I had an awesome employee at my insurance company that felt bad for me and advocated for me. After the 2nd denial (once again stating no response from my doctors office) I had the medical assistant fax all the forms (6 times in total) back to insurance with date and time stamps. Even with that information the insurance Co. would not accept this information and insisted on sending my case out for a third party review. 

I was in tears as I told the woman at the insurance company that I was going to appeal this to the highest level possible. This same gal that was really doing her best to help advocate for me at the insurance co. Said she was going to talk with the director of customer service. 

At about 3pm CST this past Friday afternoon I received a call from the Director of the clinical department informing me my medicine was approved. I had a hard time holding it together as I explained the stress and hell they put me through over a “this Safety form!” The medication had already been pre authorized for a year in December. So this Safety form was a formality they now require because of the CDC guidelines. 

I wanted to let you know about this “safety form” as I believe it’s going to affect many people. 

I was absolutely terrified that my fate was being decided by a 3rd party company. It wasn’t looking good as my insurance company claimed my doctor was basically blowing them off! I did not think the 3rd party would approve my case because of this. 

If that ended up being the case I would have had to cancel my major multi spinal fusion surgery scheduled February 14th. And I do not have any idea how I would of been able to get any meds as I would of needed to self pay. The medication I needed approved was about $1500. 

I’m so grateful to get this resolved and I can now go through with my surgery. The pharmacy reimbursed the full amount of the medication and they have been very helpful, going above and beyond to help me! 

FYI, my medication is Opana ER 30 mg. I’ve never missed any doses even tho the FDA pulled it off the market. My pharmacy stocked up on it for my pain specialist and according to my Dr he had a certain time frame to change his patients to a different medication. By the time that time limit was up other companies came up with a generic. The brand name Opana ER is made with an excellent deterrent! It is tough as a Lego toy! Hard plastic! The best deterrent I’ve ever seen. The FDA are so incompetent in my opinion. Now that the excellent deterrent Opana ER has been pulled the generic can be easily broken up into pieces and can easily be abused. I wanted to give you that feedback about the Opana ER as it just shows that once again this really shows this is not a pill problem. I believe the goal of pulling the Opana ER was to make pulling all other opioids easy for the FDA. 

Thank you for taking the time to read my story. And thank you for your helpful articles and support for people with chronic illness and intractable pain. 

https://envisionrx.com/OurDifference/WhyEnvisionRX

Why Envision?

EnvisionRxOptions is a different kind of health care company with a visibly different approach to managing pharmacy benefits. We help plan sponsors give their members the prescription coverage and service they deserve. We are fully integrated, owning all of the programs and tools we provide. This gives us the flexibility and efficiencies to save our clients’ money and help people, at all stages of life, get the medicines they need to feel better – at prices they can better afford.

Being a large national provider helps deliver the pricing our customers’ need, but being big isn’t the only thing that makes Envision better. Being nimble, proactive, fair and easy to do business with make us better. We pride ourselves on delivering excellent service and a competitive financial offer. We provide fresh ideas, listen to our clients and members, and try to make a positive difference – every day.

Using the PA (Prior Authorization) Process to Deny Necessary Medication

3 Responses

  1. I hope that the person who wrote the article about Envision Rx does not have the spinal fusion surgery as it is usually NOT SUCCESSFUL!! I worked for 30 years reviewing medical claims and usually the people in pain were the ones who had previously had spinal fusions!! Please do your research before undergoing this surgery.

  2. Kudo’s for this patient and sticking too her guns!! NEVER, EVER give in, that’s EXACTLY what they expect us chronic pain sufferers to do!! I myself have been toyed with, but after a few phone calls to the right people, and mentioning that I was going to bring a lawsuit against them for violating HIPAA policies, they did an immediate 180 degree turnabout…seems they didn’t want too fool with this old man. Unfortunately, this is only the beginning…we taxpayers as chronic pain sufferers have a long, hard road in front of us…why is the DEA now involved with my medical problems? It wasn’t like that just last year!! I sincerely believe it has EVERYTHING to do with “marijuana prohibition”, and why has the government classified it as a schedule 1 narcotic, if all these states are jumping on the “recreational/medical bandwagon”, they obviously lied too ALL the American public. If they can’t get their money by locking away “pot smokers”, well lets just demonize something else!! Lets go after the sick, and dying, cuz you know what a burden we are on society as a whole, right? Of course I am being visicious, but you see where I am going with this? One hand washes the other in this game, and we get too pay for the damn soap!! To hell and back with Richard M. Nixon, for bringing us the DEA. This is the “New Reefer Madness” !!!

  3. How low can they go?????? Bullshit!

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