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.