Tuesday, May 22, 2012

reaching 210* Fahrenheit

Wednesday Whine of the Week...

Deep breath. Yes, let's try that again. Inhale, exhale. Where to start?

About 9 months ago, my medical insurance company decided that one of my medical supplies was too expensive- my test strips for my glucose monitor. Now, it isn't like they refused to pay for them. They would pay for them, eventually, but... so long as everyone jumps through their seemingly arbitrary hoops. Deep breath.

  1. So, the Dr writes the Rx. 
  2. The pharmacist submits the Rx. 
  3. The insurance refuses the Rx. 
  4. The pharmacist contacts the Dr's office and requests what is called a "prior authorization.".
  5. The Dr submits the required prior authorization paperwork to the insurance company. 
  6. The insurance approves the Rx.
  7. The pharmacist waits a day and resubmits the Rx and hopefully everything has happened in the correct sequence and the prescription is filled.

Not once has that happened. Not once.

Now, does anyone else see a flaw in the process? There are a whole lot of places for the ball to be dropped. And how would anyone know who had dropped said ball in order to rectify the game playing? And so there might be a delay in the process.  For this reason, I try to start early. But then there's the issue of the insurance company not even considering the Rx request until they deem it's time to be refilled and the ball can't even start rolling until that time. You can't do the prior authorization prior to needing the prior authorization. Kooky. Then there's weekends and such. Days when the Dr's office is closed. Days when the insurance company loses paper work. I have to say, my pharmacist is amazing- along with the staff there. The other two variables are...variable and considerably less trustworthy.

It all sounds like a complicated whine about a simple problem, right? But there are some serious ramifications. See, I can't give up on these particular strips and settle for the less expensive strips/monitor that the insurance company will pay for the first go around.  The glucose monitor I have is connected to my insulin pump via radio waves. It's a package deal. The pharmacist understands this. But unfortunately, the nurse at the Dr's office doesn't and the insurance company obviously doesn't. Every month, I have to explain and explain. I even changed Drs because the nurse had to be hounded and reminded of that every month. Several times. And now, the new nurse says she'll get to it and it'll take a few days...???? I don't have a few days once it becomes clear that they didn't get things straight the first time. Life's a chump. 

Now that's the real problem. When your body doesn't make insulin, ya need to know where you're at in order to take care of that, manually. If ya don't know if you're high or low... Well, honestly, I don't want to die, not like that, not today.

( And ya know what? That pharmacist deserves something really special. He gave me almost a month's worth of strips using an old prescription on file. No charge, 'cause the Dr's office and the insurance company were dragging their feet. Any suggestions for an appropriate gift for service above and beyond the call of duty? )

I am just stumped. Stumped, I tell ya. Maybe today will be the day when everything works like it should.  That would be proof positive that I have entered an alternate reality.  Just way too unrealistic.

And guess what? Yesterday, the Dr mistakenly left the quantity empty on my insulin Rx. According to my pump, I have less than 24 hours... Head banging on desk. Over and over and over.


Lindah said...

Red is my favorite color. EXCEPT when it is the color of tape. And particularly when red tape is being dealt from the insurance company. And you would think the nurse, of all people, would be sensitive to the patient's needs. I'm praying for you! Right now.

Tamara said...

My step daughter in law is on a pump as well and they just canceled her medicaid. (because she married my step son and he makes too much money, but because of her condition they cant afford to insure her through is work insurance) Shes been denied disability... so i really DO understand... hang in there and take deep breaths!

and i guess all i can say is keep fighting them and be thankful that the insurance IS somehow and eventually going to pay for them!

With the extra perscription i would pretend i didn't have them and start the next round so you always have backup!!!

Sarah said...

Sounds like Bill needs to knock some people up side the head - in his ever so sweet way! Sorry for all these issues.

Love you lots!

Ruth said...

My DH has had similar problems trying to get refills and once we were on a trip and he had to get it mailed to my BIL's house and it took forever. It is such a pain!!! I do feel for you. I can't understand why you wouldn't be able to get extra strips for an emergency. What could you do with them besides use them for testing your blood? It's not like they are an addictive drug. Go figure.

anne bebbington said...

I'm so sorry for the pain and anguish this is causing you Nines - not wishing to sound 'I'm alright Jack' but I am so thankful for our less than perfect National Health Service here in the UK where diabetics both type 1 and type 2 get free prescriptions for life as their condition is life threatening without them - I do so hope you can get this sorted out - (((hugs)))

Pamela (Peni) Teel said...

Praying for Deliverance!

Synthia said...

You deserve to whine.....big time!!!!!

Isobel said...

Okay...you are way worse off than me....my body makes insulin but in that department, I think it has Alzheimers...has no idea what to do with it so the need for pills. Old age comes with some benefits...my supplies are provided by Medicare.

Isobel said...

One more complaint...they make those little words you must type to prove you are not a robot very blurry...now for people with eyes like mine that means they are double blurry...sometimes takes me two or even three tries before I get they typed in there right so I can leave a comment. Sometimes I just give up.

Suzanne said...

Just a little thing that doesn't make any sence either-my mom was diabetic- dependent on insulin injections- our provincial health insurance would cover the cost of the insulin but not the cost of the needles required to inject the inculin! makes no sence at all!!
Good luck with your hoop dancing and red tape1

quiltygal said...

Oh how frustating for you !! Sounds as if you need another new doctor can your diabetes specialist recommend one...It amazes me how here in Aus (not sure about over there) Diabetics have to pay for needles but we give them to drug addicts for free !! go figure that one I work in a public hospital & as much as we may whinge about the system I personally think we are very lucky

Valerie said...

So sorry to hear about this - insurnace and Doctors...ugh don't get me started. Sounds like you have a great pharmacist (and I tell ya they don't make 'em like that anymore).