ComplaintsforSierra Health and Life Insurance Co.

• Initial Complaint

  06/21/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I have been working since May 11th, 2023 to fill a much-needed prescription for insomnia medication. Sierra Health and Life has been extremely unresponsive and prefers to send information via mail rather than email or phone call. Their website is unusable for correspondence or to find basic information. My prescription is currently in a state of appeals which could take up to 30 business days. I have been without medication for six weeks and have been unable to sleep the entire time. The medication is over $300 without insurance so I cannot afford it without coverage. I am unable to speak to anyone in the appeals department. I feel this is inhumane and unethical to withhold my necessary medication. I have successfully been taking this medication for two and a half years, then switched jobs and ended up with coverage through Sierra Health and Life who has unnecessarily extended this process of approving my prescription. *************** have provided all documentation they have requested and now have been told to wait. I need this medication to sleep and have a normal life and am currently suffering mental health consequences from not having my prescription.

  Business response

  06/27/2023

  Please see the attached response.  Thank you,

  Customer response

  06/27/2023

   
  Complaint: 20215073
  
  I am rejecting this response because:

  Information was sent by my doctor for this appeal on June 2nd, 2023. The appeal was rejected on June 23rd, 2023. The information sent on June 2nd was the information requested by Sierra Health and Life and they have still rejected the claim on the grounds that I have not tried two of three medications as step therapy even though, myself and my doctor submitted letters on June 2nd, 2023, with the information that these medications that Sierra ***** and Life wish for me to try are medically contraindicated and potentially dangerous to my well-being and health. Also, this is an exorbitant amount of time for review for a very medically necessary medication. I am still unable to sleep without the prescription for ******* and have been told by Sierra Health and Life  to appeal the decision again and potentially wait up to 30 business days for another decision. I have been without my prescription coverage since mid-May. I am paying for this insurance and am not receiving coverage for a much needed medication that I was on successfully for two and a half years with prior insurance companies. This is an unethical amount of time to leave me without my prescription and state that I must take medications that are dangerous in the interim to potentially have a chance at getting this prescription approved. *************** will continue to appeal these decisions but believe that Sierra Health and Life are acting recklessly in leaving me without prescription coverage with no end in sight. 
  
  Sincerely,
  *********************

  Business response

  06/30/2023

  With all do respect, the rejection is related to the continued denial of Dayvigo.  Our records indicate that a 2nd level appeal was requested and the plan is processing the request.  Please note,the information submitted to the plan on June 2, 2023, does not include medical records identifying that preferred medications cannot be taken. During the 2nd level appeal, ************** will have an opportunity to share her concerns with the Grievance Review Committee.  

  Customer response

  07/05/2023

   
  Complaint: 20215073
  
  I am rejecting this response because:

  *************** have continued to provide any and all paperwork and documents needed and are somehow into a second appeal stage for this much-needed medication. My doctor is also filing complaints on her end to the **** about Sierra Health and Life being unethical and irresponsible in continuing to deny my medication. I have never had such an issue getting a medication approved. I changed insurance three times in three years from my last job deciding to change companies each year and each company needed less than a week to get the medication back under renewal and filled. I have been without medication since May 11 and had to pay out of pocket (over $300) for the medication and will now have to fight to try to reclaim any kind of payment for this medication. I am paying for a service and the company is not delivering on their end are continuing to cause added mental stress needlessly. 
  
  Sincerely,
  
  *********************

  Business response

  07/14/2023

  Upon further review of the information, the requested medication is approved effective May 1, 2023, under your Tier 3 level of benefit.  Please contact ****** Services for assistance with yoru reimbursement if the transaction occurred on or after May 1, 2023.  Thank you,

  Customer response

  07/17/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  

  I would still like it on the record that this was an exorbitant amount of time and effort and money just to get one prescription filled and I am already receiving a lot of misinformation and redirection for getting reimbursed for money I am already out. This company is a complete joke of an insurance company and if I could afford it, I would happily switch. 
  
  Sincerely,
  
  *********************

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