HMO Plan Discrimination?

[KristiApril]

What is the name of your state? Connecticut

I currently have Anthem Medical insurance in Connecticut (formerly Blue Cross/Blue Shield). I was denied prescription coverage for acne medication because the insurance company claims that I am "too old"! Apparently, I am too old to have acne. I am 35-and I certainly didn't expect to develop this problem at this point in my life-but in any case-it's there. Anthem claims that acne medication (creams, gels, pills, etc) is only approved FOR PATIENTS UNDER THE AGE OF 25. I read through the fine print and saw nothing to state that covered individuals must be under the age of 25 to be covered for this medication. Sounds like age discrimination to me. Anyone ever heard of this?

 

[cbg]

It is not even remotely unusual for an insurance carrier to limit acne medications to those under 25, or even under 21. No, this is not age discrimination. This is a contract provision.

 

[somarco]

Did you read the section under exclusions for cosmetic treatments?

Without seeing your policy all I can do is guess.

Many times adult acne is related to stress. Thats just a wag too but may provide a clue to appealing the claim.

So how expensive is this acne med anyway?

 

[KristiApril]

Did you read the section under exclusions for cosmetic treatments?

Without seeing your policy all I can do is guess.

Many times adult acne is related to stress. Thats just a wag too but may provide a clue to appealing the claim.

So how expensive is this acne med anyway?

I paid $125.00 for Defferin Gel I am just very surprised that a provision could exist in regards to age. My dermatologist told me that she has seen a spike in adult acne over the past couple of years and that most dermatologists don't have a concrete reason as to why it is happening. Guess I'm one of the unlucky ones.

 

[cbg]

It's possible that if such conditions continue to climb that eventually, insurance carriers will either remove or raise the age limitation, but as of right now it is still much more common than not for an age limit for these medications to exist. Sorry.

 

[somarco]

The new "designer" meds are usually no more effective than meds that have been around for a while. Ask your dermatologist if there is an older med that might work, or even a generic. These options are much less expensive than the new meds.

 

[purple2]

This insurer has done nothing illegal.

Check your insurance policy to find out how to file an appeal and go that route if you'd like to try to get coverage.

 

[ablessin]

You can ask your Derm. to write a letter of medical necessity to your carrier - perhaps they will review your case and approve coverage for one of the "older" acne medications that are out there, as another person has suggested to you.

At least that way, you'd only be paying your generic or low tier copay that would be due.

It's worth checking into the appeals process and asking the Derm for that letter.

And probably yes, as adult acne becomes more common, insurers will see the trend and maybe someday make some changes to the coverage