Business ProfileforPhysicians Health Plan

I have done nothing but go rounds with this insurance company to get my medication that could literally save my life, but bc they say I haven’t had an episode in an appropriate amount of time they refuse to approve a medication that could literally save my life. How is it fair for a insurance company to to dictate whether I should have a medication that is literally the ONLY medication that can save my life if I have an episode. An episode that can be triggered by literally anything in my life, but due to me being lucky enough to not have had one in a while I’m not allowed to have it in case tomorrow is the day my condition decides that it’s the day it wants to set off. I’m disgusted that insurance companies can make these decisions based off of the minimum information about a condition that is so rare most medical professionals don’t even know what I’m referring to. I pay you out of each of my checks for you to tell me I can’t have the medication I need to possibly save my life. The medication I’ve been fighting to get for years. The medication insurance will only even consider once I’ve paid my insane deductible. You are not doctors. You do not have a medical license. You have no right to deny a medication my doctor has prescribed. A medication that is needed for a reason. A medication for a condition none of you could explain nor understand because you don’t want to pay for something that costs less then what I pay you in a year alone. You all sit there and rake in money only to deny medications that people need to stay alive. It’s not only my life supporting medication, but you’ve done it with mg husband insulin several times. It’s all just so disgusting & I won’t stop filing complaints agains companies like you.

PHPs medical policies and pharmacy program are managed by our Medical Advisory and Pharmacy and *********************** which is comprised of local physicians from various medical specialties. This committee reviews medications in all therapeutic categories based on safety, effectiveness, and cost. Additionally, certain medications have a status of Prior Authorization Required (PAR). If a doctor wants to prescribe a PAR drug, a process is in place for he or she to submit a request for approval to have a drug dispensed as a covered benefit. In some cases, this process may involve continued communication requesting additional information from a doctor to determine if a drug can be covered if the initial inquiry does not meet standard authorization guidelines.At PHP, we strive to provide members with the highest quality of healthcare coverage. If at any time a member has concerns about their coverage, or questions regarding a claim payment, a grievance procedure has been established that allows members to request a reconsideration of any coverage decision. More information about this process is included with each Explanation of Benefit (EOB) and is also detailed at www.phpni.com/contact.