Things that make you go argh.

[truepenny]

1. The Gabapentin has stopped working.

2. My (baffled) doctor has prescribed Lyrica, which my insurance company does not want to let me have. Since the paperwork couldn't get cleared up before the weekend, it will be Monday before I have a chance even to TRY this new drug. ("I want a new drug, one that does what it should"--Glen Phillips's cover of that song is BEYOND BRILLIANT, btw. And there's always Weird Al and "I Want A New Duck".)

3. This is the second time in 2011 I've had this problem, since my insurance company decided at the beginning of the year that it didn't want to cover Protonix, which I have been taking successfully for 10+ years. It would rather I take Prilosec, which is not as effective (I'm on a doubled dose, and am suspicious I may have to go back and tell my gastroenterologist that's not working either).

4. And this is with GOOD health insurance.

5. Also, our fourteen-year-old Saab has just gone pear-shaped. I think Friday the Thirteenth was just waiting until Saturday.

Comments

[matociquala.livejournal.com]

boo.

[oceankitty1.livejournal.com]

Reading this, I'm so glad I live in Norway. If the doctor prescribes a drug the state covers the cost.
If I ended up in hospital tomorrow, I could stay there for free for as long as it's needed. No insurance, no interference.
Maybe I can persuade you to move over here ? :)

[katyakoshka.livejournal.com]

Over the past year, I've learned some stuff about dealing with insurance companies.

1. You can appeal. They hate appeals, but showing that you're persistent can help. If your doctor can clearly show that those meds are the ones you need, it may help get your prescriptions approved. Sometimes, you just need to clarify that they have all the information, like that you've been on a treatment for over a decade successfully. It could ridiculously be some missed annual paperwork. Really. Or they could be hoping you'll take suboptimal treatment and go away. Even if it's just submitting the proper paperwork/information, it's still an appeal/reassessment of the claim, etc.
2. If that doesn't work, you might be able to complain to your state board. Again, doctor testimony: If your current meds aren't working, and the other ones should.

Having recently done the appeal several times (missed paperwork, missed steps, outright corporate greed) and the complaint once (was closed when the insurance company reversed itself and covered nearly all my premature son's NICU bill rather than sticking us for $126k), as well as hearing of similar insurance battles from my mother's cancer survivor network, well, I can strongly recommend being the squeaky wheel.

[talkswithwind]

At an old job, one of my coworkers was a heart transplant recipient. When my company changed health insurance carriers one year, we all got to watch him go through the appeals process. Apparently, the new insurance company didn't want to cover the very expensive anti-rejection drug he was on as there was a similar and cheaper version of it. However, he'd already gone through that process two insurance companies ago (not coincidentally, the insurance company that ended up denying him coverage because he hit their lifetime max coverage amount) and knew very well it didn't work for him

He really didn't want to go through the whole 'prove it doesn't work, then get an appeal' process. He ended up paying out of pocket for the several months it took for them to get around to actually covering it. It was staggeringly expensive, but it wasn't something that was optional. The squeaky wheel got greased.

[michaeldthomas.livejournal.com]

*sigh* We've been lucky with meds so far, but our insurance plan just added some new prescription "counselors" starting July 1st. I have a feeling I'm going to lose some of that month to getting doctor's letters proving that Caitlin's epilepsy only responds to Sabril.

Oh, how I loathe the insurance tango.

[bluestalking.livejournal.com]

That is all rubbishy rubbish.

[zelda888.livejournal.com]

The Austin Lounge Lizards also have plenty to say (http://www.superlyrics.com/lyrics/kGRUDv7KES@H@c/The_Drugs_I_Need_lyrics_by_Austin_Lounge_Lizards.html) about pharmaceuticals (http://www.youtube.com/watch?v=ATOtL_N7jn4) and insurance companies (http://www.austinlizards.com/?section=music-17). Good for a few laughs, too.

[delazan.livejournal.com]

Since your husband and mine work at the same place, I'm gonna guess that you have the same insurance, and I've been through the appeals process. Yes, you have to be a squeaky wheel, and you'll probably have to take the generic of Protonix (which works just fine), but the insurance will cover it if you and your doc are squeaky enough.

I'm thinking about moving to Norway, too. Better for being a mom.
-L.

[mrissa.livejournal.com]

"And this is with GOOD health insurance" is a sentence I have repeated I don't know how many times. I'm sorry it's relevant to your life at the moment.

(Also "and this is with GOOD doctors." Sigh.)

[jry.livejournal.com]

Bummer about all the suck.

I just wanted to thank you vociferously for introducing me to Glen Phillips! I'm a huge fan of Nickel Creek and Chris Thile (OMG, best live shows ever) and somehow hadn't run across him yet.