I try really hard to not get political on my blog. Not everyone agrees with me about political issues and as much as I enjoy a good debate, I've found that not everyone else out there is as capable as playing nice as I am.
That said, today I am so furious about something that I just had to write about it. I don't think the reasoning behind my anger screams one side of the debate or the other and frankly, I suspect this is an issue about which all sides could agree.
A few minutes ago, I got into a fight with my insurance company.
Actually, that's not correct. I got into a fight with the pharmacy that my insurance company owns and insists that I use if I want my medication to be covered. It's a mail order pharmacy, which means I have to calculate how many days in advance I need a refill and then remember to call.
It's a real pain in the butt.
Today I needed two refills so I placed the order and was told that I'd receive the package tomorrow. Then I got a follow-up call asking that I call back to resolve a "problem."
The "problem" it seems is that the pharmacy had decided that I had requested one of my refills too soon. True, I do have a nearly full bottle at home, but I figured since I was refilling one prescription, I'd ask for the other as well. They informed me that I was not authorized for a refill of the second prescription until Friday.
Which would have been fine. Annoying, but fine. Until the lady said, "Well you're only taking a 1 cc dose so you should have plenty left."
I responded that in fact I was taking a 1.5 cc dose per my doctor's instructions.
"Well that's not what I have here."
Now I'm mad. I hate getting mad on the telephone because it never ends up solving anything and most of the time is counter-productive, but this biotch was not going to tell me what MY doctor and I decided would be my dosage.
It's not like the medication was Valium or Oxycontin, something addictive or that could be sold on the black market. I'm refilling progesterone in oil, for pete's sake, a drug whose side effects include weight gain, heartburn, painful injection sites, and constipation.
Ooooh I know all you ladies out there are going to be in the seedy underbelly of your local communities tonight to get your hands on a fresh batch of progesterone in oil, aren't you?
When Husband and I first started seeing our fertility doctor, I had to do an intake with the insurance company to make sure that we had exhausted all our fertility options before they would agree to pay for a specialty physician. The intake was shockingly invasive. I spent an hour on the phone detailing my sexual and reproductive history, as well as Husband's.
Not to a doctor. Not even to a nurse. But to a random lady with a checklist who happens to work for our insurance company.
Now we're very lucky because our insurance does cover a great deal of these treatments, when many other companies do not. We also pay for it, rather royally each month so it's not like we're getting something for nothing here.
However, I don't think it's appropriate for us to completely trade in our privacy in order to get this coverage. If my doctor increases my dosage of medication, it's my business, not the insurance companies'. It's not like I was claiming he had prescribed some new medication. It's the same medication that I've been taking for six months and I need some more.
Thankfully, my doctor decided today to decrease my dosage so my one remaining vial of progesterone should last until the insurance company decides to send me some more. They also claim that I should receive my second medication tomorrow, when I need it (although last time they ended up farming the order out to another company that promptly lost it and didn't send it out until the following day).
I can't help but think that this would all be resolved if they would just let me go to the freakin' corner pharmacy and refill my prescriptions on the day that I need them, but nope, their business model is to sit in a building 1000 away and send out medications when they, not the doctors, decide that patients need them.
And people say we don't need health care reform in this country? Baloney.
Monday, June 6, 2011
10 comments:
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Oh geez, what a pain! I had a similar situation at CVS a few years back when I was going on my honeymoon and they wouldn't give me my prescription refill early so I could take it with me!!! It sounds like the process here was ridiculously invasive, likely because the insurance companies want to dole out as little $$$ as possible. We're at their mercy...
ReplyDeleteSorry about your medical drama, but I'm glad you're back. I missed your blog!!
ReplyDeleteWow...that stuff sounds great - wonder if I could get my hands on some ;o)
ReplyDeleteFeeling your pain - we fight with our provider it feels like daily!
I had to use accutane when I was in college and had the worst time trying to actually obtain it. The federal government decided to heavily regulate it in order to try to eliminate the number of births to women using the drug (accutane causes TERRIBLE birth defects). I don't have a problem with the govt deciding to regulate it...the problem is how they decided to regulate it. They created a bullshit internet system called iPledge that requires you to fill in two forms of birth control you're on, and if you mix up the order, you and your doctor get locked out of the system for an entire month and can't get that month's prescription. You have to fill out online questions after you get your prescription but before you fill the prescription, you have a set time limit that you have in order to fill your prescription, you have to get a blood test 3 days before the doc appointment and a pregnancy test before the appointment (but you have to give them enough time to process the sample, so you can't go right before the appointment, and you can't go the day before if you have an early morning appointment or the system will lock you out). The system is so screwy that I had to go to three different pharmacies just to find a pharmacist who could actually operate the system. I had to go to the university doctor to get it b/c many dermatologists aren't even willing to go through the hassle of dealing w/ the system, so they just send patients elsewhere.
ReplyDeleteI have no idea what the solution to our healthcare problem is. It's evident that we have one. But just getting a glimpse of the government's system of dispensing accutane scares the shit out of me, b/c the government doesn't seem to be any more competent than the insurance companies :( Whoever created that system should be fired. They may have prevented birth defects, but that's probably b/c most women can't even obtain the drug, not b/c their system somehow does a better job of ensuring that pregnant women aren't getting the drug.
And the insurance companies gave me hell the other day about getting a refill of birth control pills...seriously, what if I was going on vacay and wanted to pick them up early b/c I would be out of town by the time I would be authorized to get them? It's like the insurance companies (and the fed govt w/ re to accutane) don't have any idea that PEOPLE who have various circumstances and needs are trying to obtain medicine and healthcare services. We're not machines w/ timers on us.
Sorry for the rant, but I can totally relate to this post.
-Kelly
Yeah, I can relate as well; I mean, indirectly I guess. When my Dad was retired, he and my mom had a similar pharmaceutical plan where they could ONLY get mail order meds. It was a real nightmare, with them regularly "losing" prescriptions, like your experience. And in my Dad's last few months, he was put on coumadin, a med for which the dosage changed almost weekly based on his bloodwork, and he had to fight tooth and nail to be able to pick it up at the local pharmacy (there were, incidentally 4 different pharmacies within a few miles of his home, which was the crazy irony of it all). People should absolutely not have to go through that; really NO people at all should have to deal with any of this nonsense, regardless of socioeconomic status or health issues.
ReplyDeleteAnd OMG I can't believe you had to share all that detailed information with someone from your damn insurance company; what absurdity. If your Dr. writes a prescription or recommends a particular course of treatment, that really should be the end of the story; I'm pretty sure they know what they're doing.
It will get 1,000 times worse with Obamacare. And no we don't need health care reform we need tort reform. As a lawyer, I am sure you don't like to hear that; however, most of the buracracy and cost is due to lawsuits. In Illinois, OB/GYN pay $100,000 in malpractice insurance premiums each year. And the laws/forms/witness/third parties are documentation for potentional lawsuits.
ReplyDeleteThat's just plain ridiculous Kathleen. Move to Canada lady! We'd love to have you. :)
ReplyDeleteSuz - Yes, it's very annoying, especially since these prescriptions are crazy expensive so it's not like I can just go behind the insurance company's back! Arg!
ReplyDeleteVictoria - Aw thanks on both counts! I didn't realize that more than a week had gone by! I'll really try to post more often (and even some outfits too hopefully!)
Tracy - Oh I definitely recommend it. Even my nurse was joking, "Kathleen, I know you are asking your husband to give you TWO shots a day instead of one since you love the progesterone so much." LOL
Kelly - Ugh I remember when another blogger (Robin, maybe) was trying to get accutane and she was posting about all that nonsense. I always laughed about the hard time insurance gave me about my birth control pills. Um, would you rather just have to pay for me having a kid? They kept raising my co-pay and then one day I realized that they were literally only paying $0.48 of the price so I just told CVS not to run it through insurance and then I could pick up my meds whenever I wanted! Bawahahahah!
Sarah - Yeah I totally would have just been annoyed if she hadn't started questioning me about my dosage. The kicker is that these meds really aren't even specialty (like some of the other infertility medication) so they are literally available EVERYWHERE! But nope, I have to order from Timbuktu!
missy - Tort reform wouldn't affect my job in the slightest. I'm open to any idea that has potential to work but even tort reform can't remedy a situation where insurance companies are second-guessing a doctor's decision on medication dosage.
dajana - Ha - seriously! A few years ago when my mother-in-law was very sick with cancer, she and my father-in-law tried to reactivate her Canadian citizenship (she was born/raised there) to get her on the health care! I told Husband (who can claim Canadian citizenship due to having a Canadian parent) that he should do the same thing so we could both get in on it! LOL
For now, the place to register your complaint is with whoever chose the insurance company, ie, very likely the employer. IF health insurance ever gets de-linked from employment, THEN you will have the power to shop around until you find a medical insurance company whose rules are the least stupid. I still remember the "good old days" when I had this wonderful health insurance company that had essentially no rules beyond "put the medical bill into an envelope to us and we'll reimburse a flat 'x' per cent" -- which also encouraged me to find the most economical physician/ hospital etc. Ask around among similar patients -- is there another medical insurance company that some of them prefer? I know the situation is not easy: my medical insurance company is but the best of what I consider to be the bad options. The problem with ObamaCare as currently conceived is that it very likely will destroy the market for privately-held medical insurance, in which case you will have only ONE option: ObamaCare. Another issue is that sometimes you just have to accept that getting the medical care you want is going to cost real money [ask me about the cost of cancer treatments -- eg, the injectable medicine where the version with a sharp needle costs ten times more than the version with a less-sharp needle -- the choice being up to the patient].
ReplyDeleteI have had a few horrible incidents with mail order pharmacy--like when they told me that had to have my dr. VERIFY that I needed the name brand (which I have been on for about 9 years) since a generic is now available. Like, I asked and paid for overnight delivery and they didn't sent it out that way and I got it 2 weeks later and I had to pay for a refill from my dr at the local pharmacy and paid $80+ for a 30 day supply, when the 90 day supply costs my $75 and I had no choice because I was out of my supply and the half-life of the drug is very short before you get side effects. Oh and did I mention I was the one following up and get nothing but bad customer service?
ReplyDeleteWhile everyone likes to blame Obamacare, at the end of the day, insurance companies are FOR PROFIT. They have been deciding what treatments, drugs and procedures they will pay for for years. And if you don't think they are deciding your healthcare...