Remember my post about Sophie's health insurance? Review it here. You might also like to read the comments because I had the beginnings, I think, of a real posse.
And remember when I told you about the new drug that Sophie is taking? Here and Here.
Well, last Friday I went to our neighborhood Rite-Aid to refill said medication and the pharmacist told me that the drug was "backordered" and his distributor had no idea when it would be available. He then told me to "call around" and see if other drugstores had it in stock.
I called CVS, Walgreens and a couple of other obscure places with no luck. When I began my enquiry each pharmacist said in that inimitable Indian English accent, "What drug is that? Can you spell it? I don't know this drug?"
Given that Sophie is "Patient #140," I'm now starting to think that she might actually be the only patient currently on Banzel (who comes up with these names?). I spoke with the Neurologist who directed me to a hospital pharmacy. They had it.
So, this morning I drove over to the hospital and parked in the parking lot. I went up to the third floor and into the drugstore. I handed over Sophie's insurance card, and the cashier disappeared for a few moments. When she returned, she handed me a receipt and my card.
"Your insurance company says this drug is not on the formulary. The drug costs $589.00." (it's a one month supply).
My blood pressure began to rise.
"What do you mean, they won't cover it? It's a refill!" I said.
"Sorry. You'll have to contact your insurance company."
So I whipped out my cell phone and waited for about fifteen minutes as the battery wore down. I'm not going to belabor this post, but the insurance agent politely argued with me for a few minutes and then decided that the drug "was covered" and proceeded to give the authorization to the pharmacist.
I got the drug.
I'm sick of this shit. There. I said it.
I could scream, vomit and cry for you. I have been there and it is a nightmare. Like that final scene in Rosemary's Baby when Mia Farrow gets to the Doctor's office and she thinks she is safe, only to discover he is part of the coven and he hand her over -- back to them.
ReplyDeleteLove the photo!
I'm so glad you shared this. Thank God Scott is just like you are and he doesn't take "no" for an answer or just accept it when someone tells us something isn't covered because I am a complete wuss and I tend to be averse to confrontation. Sadly, I don't think I'm alone in my meekness about these things. I think it's an intentional ploy for insurance companies to do this because they bank on the knowledge that there are a lot of doormats like me who would just shrug and hand over a credit card. I am so glad you stood up for yourself, for Sophie and in a way, for the rest of us.
ReplyDeleteI am so sorry> I have had my own hellish battles with my insurance and surgeries resulting in the now need to declare medical bankrupcy. Great job fighting a worthy fight, but fuckall- you shouldn't have to.
ReplyDeleteWTF?! It's almost the insurance companies do this just to see if you'll roll over and take it.
ReplyDeleteAs I read your post I was reaching for my phone - who could I scream at - you beat me to it!!! I wonder sometimes - why does it have to be soooo very hard to get help for a child???!!!! Huge hugs and a cup a tea for you!!!
ReplyDeleteHang in there hon - love the posse!!! Sarah
Oh shit!
ReplyDeleteYou need one of those cool dogs to bring with you next time....
For $589 a month that drug should do stop seizures, cure cancer and create world peace!
ReplyDeleteI hope that there is an advocate assigned to your family to help you with this nonsense! When we were dealing with drug issues, our insurance company paid a nurse-advocate to be on OUR side against them (go figure!), and she helped fight battles re: whether a drug was necessary. The cost, whether it is covered, who HAS it in stock(!)...is an advocate available to help you in this maze? You have been at this far longer than we were, so I am sure you have all of your "posse" members lined up already. As if you need more work! May God bless you and give you all of the resources you need, when you need them...posse included!
ReplyDeleteSign me up for the posse. I've got 2 dogs and I'll rent a horse if need be. Jesus.
ReplyDeleteYou and me both.
ReplyDeleteGlad you stood up to them. How is your drug coverage arranged? Is it covered through the main insurer, or do they subcontract to another entity? For example, we have a BCBS plan that subcontracts drugs to a vendor called Medco. There's a portal on the BCBS website that takes you to Medco's website, as well as a separate line for Medco.
You can try to protect yourself for next time by checking into a couple of things (apologies if you've already done these things):
1. check the website, if possible, to see if that drug is listed under you plan and what the coverage level is. Often, big insurers/drug vendors have this info on the website.
2. make sure that Sophie doesn't need what's usually called an "authorization" letter for this drug. For example, Robert takes Prevacid Solutabs, which, believe it or not, are more expensive than the seizure drug. We have to have an authorization letter on file that must be renewed each year by the physician. Sometimes you're not aware of that b/c they'll give you a new scrip for one month of any drug, plus one refill. But then that authorization process kicks in. If you do need one, you'll need to coordinate your doctor's office with the insurance company to send in authorization. And then follow up.
3. If you have a mail order option, use it. Drugs like that are much easier to deal with mail order. Usually the insurance company has a better rate with a mail order company and you can get a three-month supply at one time at a lower cost than going to the pharmacy. If you have a scrip with refills, the giant Pharmo-Barn from which the meds come will have it or get it.
Long, long, long.
I hate hate hate this kind of crap. Don't they know you already have your hands full times 100? Nothing boils my blood faster...and I simmer long after the resolution because of the time lost. thanks for sharing - as always I don't like that other people go through this but it does make me feel less alone.
ReplyDeleteOnly now catching up on my blog reading from all the out of town trips. WHOA. You handled that situation better than I would have.
ReplyDeleteI haven't yet posted about my latest insurance adventures. Just thinking about it makes my blood boil.
ReplyDeleteThe kids got new (state-sponsored) health insurance -- Anthem Blue Cross -- as of February 1 and they decided to require the doctors to preauthorize all of the expensive meds.
We waited for THREE WEEKS on three meds -- psych meds! -- and he actually ran out of them. The insurance company said that he uses too much of these meds in a month. Uhh maybe because that's how many it takes for him to be stable? Who are they to determine that is too much?
The doctor faxed the form three times. Turns out they put the wrong member # on it. Apparently it was too much work to figure out which patient they were sending auth for. That finally got straightened out and the insurance company rep said it would take 24 hours for approval. 48 hours later... It still didn't work. Finally our pharmacy tech at the local Walgreens took pity on me and called the insurance on my behalf, and finally got it figured out.
If they hadn't worked it out, Anthem Blue Cross would have been paying for a very expensive psych hospitalization for Ricky. I guess they'd prefer that?
We are probably going to have to go through this with all of his meds. Again. Right after we just finished dealing with HealthNet over the same ones (the state dropped them as a vendor which is why we had to switch to ABC). They were totally useless as well.
Anyway, I sympathize!!! Sorry this turned into a novel. Maybe I'll just copy and paste it to the blog...