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1 out of every 3 prescriptions has to be justified by my doctor before NALC will cover them
Posted by YikYum on 08/12/2009
WASHINGTON, DISTRICT OF COLUMBIA -- 1 out of every 3 prescriptions has to be justified by my doctor before NALC will cover them. And when my doctor wants to try different dosages my prescriptions are rejected unless I use Caremark, a mail order company, I do not have time to send in a prescription and wait 10 days to get it filled. I'm currently spending 3-4 hours every 2 weeks on the phone, Faxing letters, and running to my doctors to pick up letters of justification. NALC fights 1/3 of my doctors plans, causes significant delays in my medication. If you have a choice you should NOT choose NALC (CIGNA) for your insurance!
     
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Posted by goduke on 2009-08-12:
I imagine you are using some high dollar RX's, using some newer therapies, or are taking some drugs which have generic or OTC alternatives. You're probably going to be doing this no matter what plan you have. It's what NALC agreed to.
Posted by MSCANTBEWRONG on 2009-08-12:
That's unfortunate. You would think if there was a legal prescription, your requests would be justified. Will your Dr give you a justification letter when he prescribes or makes changes to your medication and dosages? It may save you some time.
Posted by charlene2 on 2009-10-30:
We are having NALC PPO (government). This is the worst medical insurance we have ever had. Bad choice. High copays on regular routine visit. No routine coverage on vision. No dental coverage. Most of the labs work are not covered eventhough requested by your primary physicians. When we call for questions about the benefits, we were put on hold for more than 30minutes, then were transferred back & forth to these representatives with attitudes. Bad service. Do not choose NALC PPO unless you want to pay most out of you pocket & have patience dealing with bad attitudes
Posted by Wendye in TX on 2012-04-30:
I would like to say that I changed pharmacies because this ins did not include Walgreens, so I went to CVS. I have had nothing but problems with CVS, and would like to go back to Walgreens, with whom I never had a problem. While looking at the list of pharmacies the NALC does business with, there are few in my area...which is central Texas. It seems the list is for those of you in large metro areas in the North-East. We do have Kroger, but they are about the most expensive in our area. I thought Walgreens was everywhere. Why can't NALC make a deal with them, for those of us who used them religiously before signing on with this ins?? I guess they will say that's my problem...
Posted by GovtEmployee on 2013-06-21:
I have NALC, and they are terrible to work with. We have a number of bills that should be covered and have not paid and are going into collection despite repeatedly calling them. NALC tells us they are trying to work with the hospital and resend the bill and the hospital says NALC will not respond or call back.
Posted by Leon Steczynski on 2013-08-10:
Thank you very much for your comments. I was considering changing to NACL during open season, but your reviews have convinced me to stay put!
Posted by sheryl on 2013-08-27:
Do not use NALC insurance we have had major issues with getting our prescriptions. we will be changing companies next year.
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PPO being run like an HMO
Posted by Jo.allan on 01/20/2012
CALIFORNIA -- Since CIGNA took over management of NALC, my health care seems more like an HMO. Referrals for an MRI take an inordinate amount of time, my doctor's decision to order an MRI have been questioned, and the site selected by CIGNA is considered sub-par by two of my doctors. The site chosen for the MRI by CIGNA is a site available to people without insurance in California and the care is considered less than ideal by doctors in my area. Instead of choosing a site from the Preferred Provider List, one must now call into CIGNA/Med Solutions, speak with the person handling your case, and then choose from a list that he/she provides. Then, instead of being able to contact the MRI site (or any other site) myself, I must wait on the line while my "handler" calls the chosen site, speaks with the appointment desk, and then allows me to confirm a time and date for the MRI.

Furthermore, I was transferred 3 times within the CIGNA/Medsolutions labryinth before I actually spoke to the "handler" (my term). I received a letter in the mail today confirming that the MRI would be covered, however, the site mentioned in the letter was not the site where the appointment was made. Also, the MRI ordered by CIGNA was for the thoracic area - not the correct area!! I needed a cervico/lumbar MRI. So now the process must begin again and, needless to say, treatment is being delayed because the diagnostics are being delayed. Can't wait for July when I become eligible for Medicare. I was dreading this transition, but now I'm prepared. It can't get much worse.
     
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Posted by Court on 2012-03-06:
Cigna doesn't order the MRI, your doctors office gives them a CPT code representing your test... So that part was your doctors fault.

Med solutions is a horrible company, can't argue with you on that one. Deal with them daily.
Posted by Green Acres on 2013-01-21:
MedSolutions is a terrible company. They are slow to respond and generally say no to more expensive tests. They use the pretext of saving the patient from radiation exposure, but it's really a money thing for them. Check out the lawsuits against them, as well as the Delaware case.
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