sleep2dream614 Posted April 30, 2014 Share Posted April 30, 2014 Hi. I have been currently taking ambien for 3 years and its the only sleeping med that works. However I had to change my insurance due to it not meeting obamacare. I was receiving 30 pills for 30 days . my doc had me prescribed it nightly but now with my new insurance its 15 pills every 25 days :/. My doctor even tried to override it with a preauthorization but the insurance still said the will only cover 15 pills and I can refill the 25th day. I find it really silly. I have tried the over the counter meds and natural meds and even did the sleep hygiene for years and none of them have worked. Ambien was my last resort. So anyways I go 10 days now not sleeping well and its effecting my mood. I don't want to add another med but idk what to do. Any suggestions? I thought about splitting the 10mg but 5mg does nothing. Link to comment Share on other sites More sharing options...
mcjimjam Posted April 30, 2014 Share Posted April 30, 2014 Maybe you could see a sleep physician? Your insurance might give his opinion more credence because he is a specialist in that area. Link to comment Share on other sites More sharing options...
shesellsseashells Posted April 30, 2014 Share Posted April 30, 2014 There should be an appeals process of which you can take advantage. Ask for a copy of the policy's Summary Plan Description and ask the insurance company to tell you to which section they are referring when they are denying your doctor's order. If they deny your appeal you can file a complaint with your state's agency that oversees health insurance. If your health insurance is through an employer you might speak with HR--some companies have advocates that can help you with insurance companies. If you have insurance through one of the health care exchanges or from the government there are representatives that can help you. Link to comment Share on other sites More sharing options...
dopamine Posted April 30, 2014 Share Posted April 30, 2014 Hi. I have been currently taking ambien for 3 years and its the only sleeping med that works. However I had to change my insurance due to it not meeting obamacare. I was receiving 30 pills for 30 days . my doc had me prescribed it nightly but now with my new insurance its 15 pills every 25 days :/. My doctor even tried to override it with a preauthorization but the insurance still said the will only cover 15 pills and I can refill the 25th day. I find it really silly. I have tried the over the counter meds and natural meds and even did the sleep hygiene for years and none of them have worked. Ambien was my last resort. So anyways I go 10 days now not sleeping well and its effecting my mood. I don't want to add another med but idk what to do. Any suggestions? I thought about splitting the 10mg but 5mg does nothing. Can you afford to pay cash for the remainder of the pills? Might be worth it for the extra sleep. The website www.goodrx.com has coupons that can drastically reduce the retail cost. I did a quick search of generic Zolpidem in my area and it's available for $6.94 for 30 tablets. Not sure if they will combine the coupon with insurance, but if not I would just not use insurance and use the coupon if it's cheaper. Link to comment Share on other sites More sharing options...
bpladybug Posted May 1, 2014 Share Posted May 1, 2014 This has nothing to do with the Affordable Care Act. You and your doctor need to persevere with a formal Appeal. If that is denied then make a formal complaint to your state Insurance Commissioner. Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 1, 2014 Author Share Posted May 1, 2014 Yeah I called my insurance and they said that's just how my plan works..15 pills Every 25 days. They said they got my docs preauthorization and that maybe I should ask her to higher than dosage so I can split it to 10mg but I'm pretty sure there's no higher dose than 10 so. I have an app with her next week so idk Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 1, 2014 Author Share Posted May 1, 2014 I'll probably have to change my insurance but I'll have to wait till august since I just got this insurance last month. If anyone's wondering its caresource an ohio insurance . I was going to get anthem blue cross but it was too expensive Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 1, 2014 Author Share Posted May 1, 2014 Hi. I have been currently taking ambien for 3 years and its the only sleeping med that works. However I had to change my insurance due to it not meeting obamacare. I was receiving 30 pills for 30 days . my doc had me prescribed it nightly but now with my new insurance its 15 pills every 25 days :/. My doctor even tried to override it with a preauthorization but the insurance still said the will only cover 15 pills and I can refill the 25th day. I find it really silly. I have tried the over the counter meds and natural meds and even did the sleep hygiene for years and none of them have worked. Ambien was my last resort. So anyways I go 10 days now not sleeping well and its effecting my mood. I don't want to add another med but idk what to do. Any suggestions? I thought about splitting the 10mg but 5mg does nothing. Can you afford to pay cash for the remainder of the pills? Might be worth it for the extra sleep. The website www.goodrx.com has coupons that can drastically reduce the retail cost. I did a quick search of generic Zolpidem in my area and it's available for $6.94 for 30 tablets. Not sure if they will combine the coupon with insurance, but if not I would just not use insurance and use the coupon if it's cheaper. Yeah I tried that once with CVS asking if I could just pay the insurance with 15 and pay the other 15 with cash and they said I couldn't do it. I looked at goodrx and it says $22 for 30 pills of ambien. I'm currently paying $1 for 15 pills with my insurance. 15 every 25 days. Link to comment Share on other sites More sharing options...
KillBytes Posted May 2, 2014 Share Posted May 2, 2014 Some thing is fishy here. Ambian generic is dirt cheap. I get 30 pills for $1.45 thru my insurance and it's not a very good one either. It's cheaper then any thing else you could get a script for sleeping aide! But you do realize it's not the best right? I've had trouble falling asleep and staying asleep for a very long time. For me ambian only helps me fall asleep, not stay asleep. For me I also needed to take seriquel to help me stay asleep. Seriquel is not cheap. So to save money on meds I volunterily dropped the seriquel to save some money. So now I still have trouble "staying" asleep. But the $1.45 a month is less bothersome. Link to comment Share on other sites More sharing options...
melissaw72 Posted May 2, 2014 Share Posted May 2, 2014 Can you alternate nights? Like one night take one, the next don't take one,e tc? Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 2, 2014 Author Share Posted May 2, 2014 Can you alternate nights? Like one night take one, the next don't take one,e tc? I could try the alternate nights but I know for sure Fri sat and sun are my worst nights because I have to get up at 5am and do 12 hour shifts Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 2, 2014 Author Share Posted May 2, 2014 (edited) I thought about asking my doc to prescribe me seroquel some nights and alternate with ambien but idk. I only tried seroqul once in a hospital and it did make me go to sleep but I hear there are side effects of tremors and tarsdive .Then again every med has its woes. People do crazy stuff on ambien and I haven't had that happen.it just makes me go to sleep. I have tried lunesta and trazadone and both did not work Edited May 2, 2014 by sleep2dream614 Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 2, 2014 Author Share Posted May 2, 2014 So, I've been thinking this over. I know that sometimes, to get the meds you need, you have to think outside the box. So, could you get your pdoc to write you two prescriptions? You take one to your regular CVS. You take another to a different pharmacy. When the other pharmacy asks for insurance info, tell them you don't want this showing up on your insurance, you'd rather pay it yourself. Your pdoc should know whether or not this will work. From the way you described this, it sounds like a rule made by your insurance company to lower costs. It would be completely legal to do what I described where I live (NC). You'll need to check the legality where you live. Ohio is pretty strict I'll look into it but I'm afraid I'd end up flagged Link to comment Share on other sites More sharing options...
bpladybug Posted May 2, 2014 Share Posted May 2, 2014 (edited) Yeah I called my insurance and they said that's just how my plan works..15 pills Every 25 days. They said they got my docs preauthorization and that maybe I should ask her to higher than dosage so I can split it to 10mg but I'm pretty sure there's no higher dose than 10 so. I have an app with her next week so idk I suggest you read my post again You need to make a formal appeal talking on the phone w customer service is NOT a formal appeal and then if they deny the appeal go to the insurance commissioner and I do believe 10 mgs is the highest dose have you tried temazepam? Edited May 2, 2014 by bpladybug Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 2, 2014 Author Share Posted May 2, 2014 Yeah I called my insurance and they said that's just how my plan works..15 pills Every 25 days. They said they got my docs preauthorization and that maybe I should ask her to higher than dosage so I can split it to 10mg but I'm pretty sure there's no higher dose than 10 so. I have an app with her next week so idk I suggest you read my post again You need to make a formal appeal talking on the phone w customer service is NOT a formal appeal and then if they deny the appeal go to the insurance commissioner and I do believe 10 mgs is the highest dose have you tried temazepam? I read that but it seems like a long process. I'll look into it Nope haven't tried temazepam. Is that restoril? Link to comment Share on other sites More sharing options...
melissaw72 Posted May 2, 2014 Share Posted May 2, 2014 (edited) I thought about asking my doc to prescribe me seroquel some nights and alternate with ambien but idk. I only tried seroqul once in a hospital and it did make me go to sleep but I hear there are side effects of tremors and tarsdive .Then again every med has its woes. People do crazy stuff on ambien and I haven't had that happen.it just makes me go to sleep. I have tried lunesta and trazadone and both did not work It can't hurt to ask for the seroquel. And if you do try it and don't like it, you can stop taking it. Just keep in mind side effects can fade with time. Edited May 2, 2014 by melissaw72 Link to comment Share on other sites More sharing options...
KillBytes Posted May 3, 2014 Share Posted May 3, 2014 (edited) Seriquel is definitely safer then ambien. Still nothing beats them both together for me. I do stupid things on ambien or stuff I don't remember doing! That only happens when I do not go right to bed after taking it. Seriquel is a very soothing sleeping aide. I miss it. The only side I had on seeriquel is I was always hungry! I have a good pdoc. She subscribes larger doses then I need so I can split the pills in half. Your doc may not be willing to do that with ambien unless they know you pretty well. But you can also do that with seriquel too! Edited May 3, 2014 by KillBytes Link to comment Share on other sites More sharing options...
Wooster Posted May 4, 2014 Share Posted May 4, 2014 My guess is that your insurance company is trying to enforce the recommendation that ambien *not* be taken every night by limiting the number of pills you can get in a month. That might be why the doc's request is being denied. However, insurance companies don't practice medicine. That means they don't get to decide what your doctor thinks is in your best interests. When they start doing that, it's time to call the state health insurance commissioner and complain. Link to comment Share on other sites More sharing options...
HAL9000 Posted May 5, 2014 Share Posted May 5, 2014 I agree with Sylvan about writing a formal appeal. Also that the cash price is pretty low depending on which drug store you go to. I have to change insurance in a couple months but I think my plan is to go with a deductable plan. The Copay plan just nickels and dimes me to death. I "think" you should be able to change your policy. Or am I wrong on that ? Link to comment Share on other sites More sharing options...
sleep2dream614 Posted May 7, 2014 Author Share Posted May 7, 2014 I agree with Sylvan about writing a formal appeal. Also that the cash price is pretty low depending on which drug store you go to. I have to change insurance in a couple months but I think my plan is to go with a deductable plan. The Copay plan just nickels and dimes me to death. I "think" you should be able to change your policy. Or am I wrong on that ? Yeah I'm paying $1 for ambien with my instance which is decent but the 15/25 days is annoying. I went on goodrx and there was a discount for 30 pills for $20 and I brought it in into CVs and they said they did take goodrx but insisited that I just use my insurance and wait. How are they going to decide how I pay for my own mental health..as in getting good sleep helps my anxiety and depression. I didn't want to argue with the pharmacist so I just let it be . I thought they would flag me or something. Not only that when its time to refill its usually during the weekend when I work till 7 so the pharm is closed. I even tried to transfer it to a 24 hour pharm and they said they only allow one transfer with narcotics. Have an app with my doc this week so we can discuss what to do.maybe she could give Me a 10 day sample or maybe I need to change pharmacies. Every time when I go into CVS I feel that I'm judged. I never had this problem with Walgreen's. Unfortunately I can't even get my prescription at Walgreen's with this insurance. I can't change my insurance in Aug..which i might do I'll keep u guys updated Link to comment Share on other sites More sharing options...
HAL9000 Posted May 13, 2014 Share Posted May 13, 2014 Hi. I have been currently taking ambien for 3 years and its the only sleeping med that works. However I had to change my insurance due to it not meeting obamacare. I was receiving 30 pills for 30 days . my doc had me prescribed it nightly but now with my new insurance its 15 pills every 25 days :/. My doctor even tried to override it with a preauthorization but the insurance still said the will only cover 15 pills and I can refill the 25th day. I find it really silly. I have tried the over the counter meds and natural meds and even did the sleep hygiene for years and none of them have worked. Ambien was my last resort. So anyways I go 10 days now not sleeping well and its effecting my mood. I don't want to add another med but idk what to do. Any suggestions? I thought about splitting the 10mg but 5mg does nothing. Your freaking me out. How did you not meet obamacare??? I know its too late to do that but doesn't an insurance company have to cover you??? Link to comment Share on other sites More sharing options...
melissaw72 Posted May 13, 2014 Share Posted May 13, 2014 I know its too late to do that but doesn't an insurance company have to cover you??? Not all insurance companies cover every med. Some you have to get prior auths for them. Some aren't on their formulary. Link to comment Share on other sites More sharing options...
quiet storm Posted May 15, 2014 Share Posted May 15, 2014 (edited) It's funny to me how ambien and other sleep meds are treated. I was on lunesta for two years and had to get prior auth every time the prescription was renewed. Yet you can get benzo's, another schedule 4 medication, with no problem. Take them 3 times a day......Here ya go, here's a month supply of 90 pills for $1.95. Edited May 15, 2014 by quiet storm Link to comment Share on other sites More sharing options...
KillBytes Posted May 16, 2014 Share Posted May 16, 2014 (edited) Seriquel is definitely safer then ambien. Still nothing beats them both together for me. I do stupid things on ambien or stuff I don't remember doing! That only happens when I do not go right to bed after taking it. Seriquel is a very soothing sleeping aide. I miss it. The only side I had on seeriquel is I was always hungry! I have a good pdoc. She subscribes larger doses then I need so I can split the pills in half. Your doc may not be willing to do that with ambien unless they know you pretty well. But you can also do that with seriquel too! Seroquel is "safer" than Ambien? Where did you get this information? "Safer" has no meaning in this context. My doctor, what does she know right? Only practicing for 30 years Let me and other readers decide if it has meaning here. Thank you. Edited May 16, 2014 by KillBytes Link to comment Share on other sites More sharing options...
hagar Posted May 16, 2014 Share Posted May 16, 2014 Seriquel is definitely safer then ambien. Still nothing beats them both together for me. I do stupid things on ambien or stuff I don't remember doing! That only happens when I do not go right to bed after taking it. Seriquel is a very soothing sleeping aide. I miss it. The only side I had on seeriquel is I was always hungry! I have a good pdoc. She subscribes larger doses then I need so I can split the pills in half. Your doc may not be willing to do that with ambien unless they know you pretty well. But you can also do that with seriquel too! Seroquel is "safer" than Ambien? Where did you get this information? "Safer" has no meaning in this context. My doctor, what does she know right? Only practicing for 30 years Let me and other readers decide if it has meaning here. Thank you. Like any med (psych or otherwise), both have possible risks and both will be different for different folks. Personally, I did wacky and possibly dangerous shit in my sleep on Ambien, and Seroquel recently gave me weird blood pressure issues and disturbing rapid heart palpitations that I'm still not sure about. So, I would count neither as particularly "safe" when it comes to my own body and self, but I don't think there is any blanket "safer than" when it comes to the general population. Both can cause problems, both can be abused if you try hard enough. But plenty of people take both with no ill effects. Link to comment Share on other sites More sharing options...
condition Posted May 16, 2014 Share Posted May 16, 2014 How can ambien be abused provided that max dose for male adults is a pill per day? You mean daily use for long time? Link to comment Share on other sites More sharing options...
hagar Posted May 16, 2014 Share Posted May 16, 2014 How can ambien be abused provided that max dose for male adults is a pill per day? You mean daily use for long time? No, by "abuse" I mean taking it in ways other than how it is prescribed. Like recreationally, taking more than is prescribed at one time, and using it for reasons other than to sleep. It happens, and is probably not totally uncommon. Link to comment Share on other sites More sharing options...
condition Posted May 16, 2014 Share Posted May 16, 2014 oh thanks. So if I use 10mg daily before sleep for an extended period of time, it isn't abuse? My doc told me that I can do it indefinitely as long as I take no more than 3-4 pills per week. Link to comment Share on other sites More sharing options...
hagar Posted May 16, 2014 Share Posted May 16, 2014 (edited) I was just giving an example. Follow your doctor's prescribed instructions and ask them ANY questions you have about your medication and how you should take it before deciding to take it otherwise on your own or because of something you read on the internet from a crazy person (namely, me). Okay? Also, apologies for getting this thread derailed. My bad. Edited May 16, 2014 by hagar running Link to comment Share on other sites More sharing options...
condition Posted May 16, 2014 Share Posted May 16, 2014 Okay. Link to comment Share on other sites More sharing options...
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