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Re: NI- bound post# 178459

Thursday, 02/28/2019 11:20:08 AM

Thursday, February 28, 2019 11:20:08 AM

Post# of 425638

I actually work with insurance companies with a focus in their area of authorizations and denials/appeals - your perspective on an insurance company denying due to a benefit accruing in future years is not the case. If that was the standard, the would be denying so much more that they do. The criteria used is “medical necessity” as defined by the doctor primarily AND the insurance company on their formulary.



How do you explain decades of refusing to cover preventative care and insurance company's efforts to limit what falls under preventative care? Vascepa is a preventative medication with no (proven) immediate symptomatic benefit; instead the benefit is years or decades down the road. This is exactly the kind of medication that insurance companies fight to not cover.
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