Within the last two days I’ve been denied payment for CDE visits by Aetna, and ability to get Fiasp from Express Scripts. I’ve appealed both through Express Scripts and in the case of CDE, via the hospital (change coding so Aetna would pay) and Aetna. No appeal routes are left.
None of last year’s invoices or prescription requests were denied, although my endo needed to submit pre-approval arguments for Fiasp.
I understand the insurance companies and PBM’s business model is not-paying, but this has ramped up in this plan year for me. Diabetics are a very large population of chronically ill patients. I can imagine this is a ripe target for reducing payouts.
I’ll start getting Fiasp from Canada and paying for my CDE out of pocket.