HealthNet refusing to pay for name brand antidepressants for my suicidal son
So as health insurers frequently do in the beginning of a calendar year, HealthNet all of a sudden switched my son’s prescription from name brand to generic this year. His name brand prescription ran out a couple of months ago and he started on the generic. About half of my meds are generic, but there are some I’ve had to fight to get in name brand because the generic doesn’t work (including my antidepressant). So I was worried, but figured we’d see. He was willing to give it a chance.
He told me two weeks ago that he’s severely depressed. He isn’t showering more than once a week or so (he normally showers every day) and is suicidal (he has a history of suicidal ideation – since he first became depressed at about seven years old). He’s making it into work because he’s conscientious, but it’s a struggle.
We talked to his doctor and she put in his new prescription as “name brand medically necessary.” HealthNet told CVS they wouldn’t pay for it. My husband has been on the phone with the HealthNet representatives for hours over the last few days. They let us file an appeal but told him that it will likely be denied.
My son and I both take Wellbutrin, so I’ve been trying to get him to take mine, but he refuses, since I’m coming out of a months-long depression.
I used to work for an HMO, so I know that normally persistence and playing the game can be effective, but I’m really concerned that it’s not working in this case. It makes no sense to me. I have no idea what to do.