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Ask Law Educator, Esq. Your Own Question
Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 118068
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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Can I sue my HMO for changing the medication that they have

Customer Question

Can I sue my HMO for changing the medication that they have provided me with for over 20 years with no guasrantee of he efficacy of and training for the administation of the new drug resulting in me going 3 weeks without needed medication.r28 years
JA: Because laws vary from place to place, can you tell me what state this is in?
Customer: Georgia
JA: Has anything been filed or reported?
Customer: I am in the process of submitting a formal appeal.
JA: Anything else you want the lawyer to know before I connect you?
Customer: The medication requires daily to every other day injections. I have a fear of needles and have tried to take the new medication resulting in irritation and damage to my skin and a persistent headache for almost a week. This has also resulted in an elevated BP.
Submitted: 5 months ago.
Category: Legal
Expert:  Legal Eagle replied 5 months ago.

Hello! My name is ***** ***** I am an attorney with Just Answer. I'll be here to help today! Do you mind if I take a moment to review your question?

By the way, the system will automatically ask for a phone call. By no means are you required to accept it.

Expert:  Legal Eagle replied 5 months ago.

I'm sorry to hear about your situation. If I understand you correctly, your HMO decided to stop covering the pills that you were taking? And because you were not taking the pills, it's caused you some physical harm?

Customer: replied 5 months ago.
It is an injection that I have taken once a week for over 20 years. Now they want me to administer an injection weekly to every other day. I have a fear of needles and the medication is not provided via a pen type injection and no training was provided initially.
Expert:  Legal Eagle replied 5 months ago.

I can see what you mean. Did your doctor require this change in treatment?

Customer: replied 5 months ago.
My doctor initially requested that I stay on the initial medication, but the Kaiser Pharmacy would not authourize it any more. In my earlier message the new medication is a daily to everyother day injection.
Expert:  Legal Eagle replied 5 months ago.

Hi, I haven’t forgotten about you. I’m just wrapping up with another customer and I will be with you very shortly.

Customer: replied 5 months ago.
Expert:  Legal Eagle replied 5 months ago.

Ok, I had a chance to review your question and I apologize dearly for the delay. I realize that I am not the best person to help with this and that one of our other experts who knows a thing or two about dealing with HMOs and KP would be better suited. This means that I will opt out and let your question move back out into the question bank. Again, I apologize for the delay and I certainly hope that you feel better.

Expert:  Law Educator, Esq. replied 5 months ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
I am a DIFFERENT CONTRIBUTOR, your previous expert opted out.
An insurer can set up their own prescription plan requirements, but you have a right to appeal if the alternative medications they want to provide are not medically suitable for you. There is an insurance appeal process, which requires you to write an appeal to the insurer explaining why this medication should be issued. You will need a letter from your doctor to explain why only this medication is necessary and the other medications will not work. If they deny the first appeal, there is another step which is an independent review which is where you send another written appeal stating you are demanding an independent review of the denial and include the detailed description from the doctor regarding your needs.
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