Coventry, my adopted son’s MCO provider through Medicaid, has denied coverage for Adderall, his ADHD medication, for the umpteenth time. Attached is the appeal letter I am sending along with claim forms for the 100s of dollars I have spent out-of-pocket for them over the last year or so.
My son is not the only one I have heard of having many claims denied by Coventry. If you or anyone you know has had problems with this company, please let me know. They don’t provide coverage for kids’ behavioral medications. Then, when the kids have a meltdown because they don’t have their meds, they don’t cover residential services. This really needs to stop…
Re: Bersain Barlow
To Whom It May Concern:
For well over a year since Coventry has become my son Bersain Barlow’s MCO provider, one of his Adderall prescriptions has been denied for coverage at least once a month. He takes 20 mg Adderall in the am, 10 mg Adderall in the pm and ½ Tenex twice daily for ADHD. He is prescribed the medication through UK Psychiatry, and he needs it in order to attend school.
Many and various reasons have been given for the denial of coverage, including problems with a provider number, that Coventry will only cover one prescription per month, that the 100 pill per month ceiling has been exceeded (according to an employee with your company per phone call of Monday’s date) to no reason at all. Bersain does not take 100 pills per month. He takes 90, including 30 Adderall 10mg, 30 Adderall 20mg and 30 Tenex.
Prior to Coventry’s taking over Bersain’s Medicaid coverage, there was never a problem with getting his meds covered. The amount and dosage of his prescribed meds have not changed since before your company took over his coverage. He was able to keep his Medical card subsequent to his adoption. I will make sure he has the medicine he needs even if I have to pay out-of-pocket. So far, I estimate that I have spent @$500 on medications for him that Coventry has not covered in the past year. However, I worry about other Medicaid children whose parents may not be able to afford meds plus other expenses. If Coventry is denying other children’s medication needs (as I have heard from pharmacy staff), I am sure their school performance will suffer. I doubt Coventry will cover their residential stays when they get either suspended or expelled from school either.
Please resolve this matter so that Bersain, as well as other children, can have behavioral medications needed to attend school covered by Coventry. Additionally, please process the enclosed claim forms so that I may be reimbursed for some of the out-of-pocket expenses I have incurred due to the improper denial of coverage of Bersain’s medications. Receipts that I have been able to locate are enclosed.
I look forward to your speedy rectification of this situation so that no further action need be taken. If you have any questions in this regard, please contact me at the above address or phone number.