Insurances and medication?

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Monty's Mom
Veteran Member


Date Joined Aug 2010
Total Posts : 664
   Posted 9/10/2010 11:51 AM (GMT -7)   
I hate coming on here only to complain, but I need to know if anyone has suggestions.
 
I had to change insurances as of September 1st, and according to the formulary for drugs, my fentanyl patch is on it and an accepted medication with a prior authorization. So we got everything required I thought, since my doctor's office called to let me know my script was ready. I get a ride, go the 20 minute ride to the office in the only ride I could get, a jacked up bumpy truck driven by my good friend who is not used to driving a manual transmission, and we take it to the pharmacy. We also stopped for breakfast out.... but that is totally unrelated. Anyway, the pharmacist informs me that the authorization was denied because I haven't taken morphine pills since joining their insurance plan.
 
I kept my temper even though I wanted to drive back to the doctor's office and punch them in the faces, and called the insurance company. I spent precious cell phone minutes explaining that I have tried it, but it doesn't provide lasting relief and makes me throw up all the time. Apparently it doesn't matter. I still have to take the morphine pills first for 90 days to establish that they arent helping me and that the fentanyl patch is called for. Has anyone else had this happen? My doctor's office is trying to get it overturned by submitting medical records, but I find myself without adequate pain control for the time being. The major issue is that I have church activities this weekend, such as making cinnamon rolls for our coffee hour, my fridge needs filled since its empty, and a craft project for our Mothers of Preschoolers group Sunday afternoon. How do I handle any of it without any medications beside tramadol and Vicodin? I have been on the patch for over a month. Will I go through withdrawal? What do I do? My doctors office is hopeful that it will be overturned today, but what if it isnt? I asked for a prescription to handle any withdrawal symptoms, which they will not give me unless the auth isnt finished.
 
I am sure I am not the only person with this issue or something similar before. Does anyone have any suggestions?
 
By the way, at the gas station next to my pharmacy where my friend took me in for a cup of coffee, I found a new customer for Mary Kay in the oddest way. I told her that her makeup looked great, she said the same about me, and we both use Mary Kay! She just moved here a few weeks ago from the midwest, and is looking for a local MK lady! One good thing today huh?  Look on the bright side right? Well, I tripped out the door on my way to the truck, so hopefully she wont mind buying from a clutz!  Also, you should have seen me climb into this jacked up truck at every stop. I had to bring my own milk crate just to be able to get in!
 
Thanks in advance for the advice everyone~!
Mindy
The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them. That's the essence of inhumanity. George Bernard Shaw


Pelvic adhesive disease, Irritable bowel syndrome, SI joint pain, 7 pelvic surgeries for pain, ovarian cysts, adhesions, and a kidney stone! Wait, future medial transcriptionist I must say ureteral calculus!

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2279
   Posted 9/10/2010 12:12 PM (GMT -7)   
Hi Mindi,
I've run up against similar issues.

Usually it will work if you get a letter from your doctor to the insurance company explaining why you can't tolerate the morphine. He should list every possible reason that applies to your case. You should not have to try something you've already tried & didn't tolerate just b/c you switched insurers.

That said, be prepared for them to start throwing out more suggestions (anything remotely similar that is cheaper than the patches)... Methadone, Oxy, etc. So I would say to write out a list of all the meds you've tried & what your reaction was. I had to do that recently to get approved for a new med. Then I had to try Methadone. So far, the medicine is just awful. I had 9 other meds that they recommended I try before they would approve me. I had tried all of those & had severe reactions to them all. But I still had to try the Methadone.

I'm still working on trying to take it, but basically it sucks. I know it's rough but sadly there's no easy way to get them to cover a particular med.

good luck!
frances

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 9/10/2010 7:20 PM (GMT -7)   
I have had insurance deny certain medications because they deemed that I had not tried enough alternates but I have never had an insurance company deny a medication for the reason you stated, and I have been through many insurance changes.

I am wondering if the real problem here is that your new insurance company just has not gotten your full medical/insurance history yet from your previous insurance. Regardless though your doctor should be able to demonstrate easily enough why you should not be taking morphine since you have already been on it and have had a rather violent reaction to it.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.
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