so it's a break in that sense. And it's been quite some time since I posted an I Smell Bullshit rant. Lots of sarcasm, here, and bitter, coping irritation.
Yesterday, I took Sophie to The Neurologist to discuss The State of Sophie, Inc. We went over various medication options over tea and cookies (only one medication left to try) and Sophie demonstrated one of her larger seizures, spontaneously, for The Neurologist's edification. We left with a prescription for locosamide or Vimpat, the prettier name, wished the good doctor Happy Holidays and went on our way.
Today, I took the prescription over to The Pharmacy and several hours later received a call from The Pharmacist.
Hello! We spoke with your insurance company regarding the Vimpat, and that drug is not covered on your plan. However, they suggested you replace it with Lamictal, which they will cover.
With my mouth hanging open (Lamictal? Now the insurance company is replacing anti-epileptic drug suggestions from my doctor?), I told The Pharmacist that no, we can't just take Lamictal, a drug that Sophie was on over five years ago for about seven years and that I guess I would call the insurance company and see what was up. The Pharmacist told me that he would order the drug anyway, that it cost $367 for the three week supply and that he hoped we could straighten it all out.
Here's the Christmas part of this post:
Ho!!! Ho!!! Ho!!!
I made the call to The Insurance Company (Anthem Blue Cross) and spoke briefly to an enthusiastic clerk who advised me to have The Neurologist call The Insurance Company for an authorization for medical necessity for the Pharmacist for Vimpat for Sophie. Then he wished me Happy Holidays and is there anything else I can help you with?
Ho!!! Ho!!! Ho!!!
Very frustrating. I went through the same thing with many tests I had when we were trying to figure out what was wrong with me, years ago. I had two MRI's that Blue Cross refused to pay for until I had my doctor call them and do the 'medical necessity' thing.
ReplyDeleteThen they were cleared. I hope the same for you, Elizabeth. You are a mother warrior and my heart is with you.
More like HO-HO-HOly shit. I really want to find the NURSE ADVOCATE that your insurance company must be hiding somewhere in the bowels of the building and entice her to come out and DO HER JOB for you.
ReplyDeleteNews to me that one can just swap out to the cheap-o anti-epileptic meds. Just think how much money we could have saved our insurance company these past few years!!! [sarcasm off]
ReplyDeleteThe mind boggles.
Best wishes for good Vimpat results.
So people don't want the government come between them and their doctors, but it's okay that insurance companies do that? I can't really comprehend how they can deny an anti-epileptic med that was prescribed by your doctor. How can an anti-seizure drug NOT be medical necessity? I'm so sorry you are dealing with this BS, and right before the holidays. So unfair.
ReplyDeleteIt worked out. It will work out. I believe.
ReplyDeleteGood grief, the medical insurance stuff seems dreadful. It's not so impossible here in Australia by and large. It must be so hard, hard enough to struggle with Sophie but then to endure the bureaucrats, even at Christmas.
ReplyDeleteDespite all this, I hope you get to enjoy the season
Hopefully neuro will write the letter and Anthem will pay.
ReplyDeleteBullshit is right.
xoxoxo
Seriously?? Just give her Lamictal. Didn't you know that it is a suitable substitute for Vimpat?
ReplyDeleteOh, it's not? It's a totally different drug?
Hmmm ... perhaps you should try it anyway. It's just a fucking SEIZURE med after all, nothing important.
Ugh, I am in a mood today! I am sorry Elizabeth, I hope that the inurance approves the Vimpat, but more importantly I hope that it helps Sophie!
But really- Obamacare would come between us and our doctors, right?
ReplyDeleteOh baby. Oh baby.
Anywhere else in the world this would be seriously considered to be practicing medicine without a license and subject not only to the regular rules and regulations of the law but making them extremely (and certainly well deserved) vulnerable to a lawsuit for interfering with the welfare of a patient.
ReplyDeleteI think your representatives in D.C
need to hear about this. I know you don't have time, but it may be worth it.
So frustrating. I am emailing you a surprise. Please share with your whole family. We hope you like it.
ReplyDeleteI was at the pharmacy today to fill a short-acting prescription of a medication Ace takes. She asked for generic or brand. I said brand because Ace has taken the long-acting formula for years and the insurance company won't cover generic for long acting. Except...the pharmacist types away on her computer and discovers that the insurance company won't cover brand for the short-acting. What in the hell? I just told her to give me whatever it is that they cover. At least I wasn't told to order an entirely DIFFERENT prescription medication entirely! I can never figure this stuff out...mostly because there is no consistent formula to any of this madness!
ReplyDeleteI'm ever so grateful again for our public health insurance. Battling for medicines seems totally preposterous.
ReplyDeleteI'll be laughing when you actually get the drug and not until then. Yes, didn't you know insurance company clerks are all required to go to medical school so they can prescribe? As a pediatric nurse I can tell you this happens ALL THE TIME. Years back Medicaid refused certain seizure medications and others would only be filled generic and thousands of seizure kids in our state were hospitalized over and over until the docs got together and pressured Medicaid to change the policy. I'm sure the cost of hospitalized children was astronomical compared to the cost of one brand rx.
ReplyDeleteMy medical/insurance company battles on behalf of my child only pale in comparison to what you go through, but this resonates with me and makes me want to spit bullets.
ReplyDeleteInsurance companies are fuckers.
If/when we lose our Katie Beckett waiver in 2011, I will be fighting a lot more.
Tis a crazy effed up country we live in.
xoxoxox Merry Christmas Elizabeth. Hoping it is drying out over on your side of the U.S.
Gosh, can I take a ride on the I Smell Bullshit bandwagon with you ?
ReplyDeleteBelow is a story that has been in the news this holiday season here in the wise state of Arizona. I suppose it is especially painful tale for me because we have a college-aged daughter with cystic fibrosis too and have such hopes for her future.
Tiffany Tate, age 27, has cystic fibrosis and is at about 25 percent lung capacity and is in need of a double lung transplant.
She isn't able to maintain a job because of her lungs. She is too old to be on her parents' insurance. She can't get insurance on her own because of her condition.
She was approved by the University Medical Center in Tucson last April and was put on a waiting list. In August, she said she received a letter from the Arizona Health Care Cost Containment System, saying that she no longer would be covered.
After Oct. 1, AHCCCS stopped paying for lung transplants, part of nearly $4 million in savings to keep the state's form of Medicaid from operating in the red.
Yah, which holiday? Halloween?
ReplyDeleteLamictal aka Lamotrigine at $3 a pill to be taken twice a day (and this was 5 years ago) was also prescribed to me for seizures. I had money no insurance no jobs (nothing as off putting as having a seizure during a job interview.) Jesus God on High. I'd like to visit your Pharmacist with a baseball bat and a dose of the crazy eyes hohoHO.
ReplyDeletelove,
Rebecca Feeling Helpless
Funny thing is that the doctor's prescription should indicate there's some medical necessity. He has to give a super duper prescription?
ReplyDeleteBeen there. Many times. It will work out, but it will take energy and advocacy from you, mom. What a huge surprise. /sarcasm
this. is. ridiculous. i swear you have the worst insurance ever :(
ReplyDelete