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Avmed is disingenuous
Posted by on
FLORIDA -- We have AvMed Health through my husbands employer, so I don't have any choice.

My husband's Ophthalmologist recommended cataract removal surgery for him. AvMed gave the Authorization on June 15th with date of service to be in July.

Imagine our surprise when we received notice from Avmed that the claim for the place of service was denied for lack of authorization. They paid the ophthalmologist and anesthesiologist but not the outpatient center. When we first called AvMed to see what was up, the first excuse was they never received claim. After they received proof of claim they then changed the story to the surgical center never had authorization. I have in my possession the letter of Authorization that lists the place of service, date of service and authorization number they still deny the claim. At the same time period that they did this they also denied a claim from my primary care physician for a follow up which after complaining they then approved. AvMed appears to deny legitimate claims on a regular basis using lack of authorization as their excuse, until you provide proof. It seems this may be a ploy hoping not to pay any claims. Beware and if you have any choice do not use AvMed Health Insurance. If you have to use them, make sure you do all the work for them and gather your own copies of authorizations....you will need them!
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traceylynn on 11/08/2011:
Contact the Insurance Commission in your state. I had similar problems with BCBS, one call to them cleared it up. Good luck Op and I am wishing a speedy recovery to your husband!!
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Won't cover prescriptions
Posted by on
FLORIDA -- Due to a job change we have AVMED, I went to the pharmacy to renew a prescription for Aciphex and AVMED refused to cover it. They say I need a form filled out by the doctor. I have run out of the medicine and in pain. I called AVMED and asked for help and what I should do. They said I go to the ER.

It is insane to not authorize a needed prescription, to contain costs, then recommend the ER which will be thousands of dollars. Likewise my condition is worsening which may in fact cost more.

This company does not care about the health of clients, I recommend to stay away if you can.
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Ben There on 08/22/2009:
Aciphex is one of the more expensive acid reducers... I think they are something like $5 a pill in the USA. They are probably hoping that your doctor gives you Ranitidine which is a lot cheaper for the insurance company. They are about $1 a pill in Canada so check into getting it from there.
Eloise on 08/22/2009:
I love Protonix. It works really fast, two or three days and no pain!
wolfester on 08/23/2009:
Thanks for your comments. I have taken nearly all of the acid reducers rantidine, prilosec, nexium, etc. The aciphex is the only one that has helped and I have been taking it for over a year. Now this new insurance won't pay until they get a paper filled out by the doctor, but he is closed until Monday. Meanwhile the pain in my chest has gone from my chest into my back and getting worse even though I am taking omeprazole since Friday.

It is just ridiculous that in order to contain costs and save $150, they are suggesting the ER as a covered option which will cost over 1k. We basically have government thinking in the private health care system now.

I'll have to go to the ER if this pain keeps getting worse.
tnchuck100 on 08/23/2009:
This sounds like one of the philosophy's I came up with when I worked for a government entity: "They will save money...NO MATTER WHAT IT COSTS!"
Ben There on 08/23/2009:
I would say it is more corporate thinking. "We insure just the pills, we don't want to pay for this one, we don't cover ER visits, so let him go if he wants and we will deny the claim for this expensive drug and convince his doc to switch to ranitidine on Monday"...
tnchuck100 on 08/23/2009:
Ben, the OP stated his insurance will pay for the ER visit.
Ben There on 08/23/2009:
Pharmacy plans are paid from different pots than ER visits even under the same insurance umbrella. That is why most insurance companies will give you 2 cards. Even if it is the same insurance card, the pill people have a different P&L than the med people and the management of each want to protect their own spending as that is their job.
wolfester on 08/23/2009:
I bought enough to hold me over and the pharmacy agreed to reprocess it if it gets approved. Meanwhile, I found a place online that sells gen Aciphex for the same price as my copay. So I am set.

I like that "they will save money..no matter what it costs" Maybe this mentality got the economy in the condition it is in now.

And....another call to AVMED, they said it may take a few days for the paper work so they gave me the names of urgent care centers and ER's - 50 copay. 10 bucks more than the pharmacy copay.
Barry on 01/10/2014:
More and more evidence that
AvMed is becoming bottom line
driven. Few doctors now accept
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