Just a rant about insurance

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FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/9/2009 10:00 PM (GMT -7)   
Please take this for what it is - a rant about my experience - and not turn this into a political argument.
 
I moved in May and started a new job in Sept.  Thank God I stoked up an extra 6 month supply of medication.  I have seen a new doctor and am staying on the same meds.  I have the same big insurance company, just a different contract b/c of the new employer.
 
My protonix was denied.  My doctor did what he needed to do and told him it was medically necessary.  It was still denied.  I am now in appeals.  They want records that I have taken and failed prilosec, prevacid and nexium, once and twice per day.  I have.  But, my doctor who prescribed them no longer practices and it was 15 years ago so I can't get the records.  But, I had the same insurance company then, just different contract.  They should have my records.  I can't believe they can't take me or my doctor at our word that this is required.  Who are they to tell my doctor what he can prescribe me.  So I switched to Nexium during the appeal.  Within three days I was in excrutiating pain.  I went and bought my protonix, generic, out of pocket for $115.  I requested in my appeal that the insurance company reimburse me.
 
Then, to get my pentasa I have to go through their mail order.  My script never came even though I could see it was sent according to my electronic medical record.  When I call they said they never received it from my doctor so they just cancelled my order.  Oh nice, so instead of a phone call to say there was a problem or calling my doctor to find out if it was sent they just cancelled it.  That was 3 weeks ago.  Now I am starting again, waiting for my doctor to send them the script.  They at least offered to expedite shipping b/c of their error at no cost to me. 
 
On top of that my husband just had a cleaning and the insurance company is now trying to deny that and charge us $200.
 
I'll be honest, I had a melt down over this today.  I ended up in tears on the phone with the pharmacy and my doctors office.  This should not be so frustrating to just keep getting my regular maintence meds that I have been on for years.
 
On top of that, I have to deal with all this during work hours.  I bill my time in 6 minute incriments.  I spent 45 minutes today and three hours the other day dealing with all this crap.  Three hours writing and faxing an appeal.
 
And I am a pretty healthy person needing maintence drugs.  How do the sick manage this? The insurance industry is just absolutely out of control.
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/9/2009 10:03 PM (GMT -7)   
I just wanted to add that my disease barely interferes with my job. It is my insurance company and the hoops I have to jump through that are messing up my day. I understand they want to keep costs down but how does it help their bottom line if people don't take their meds and need surgery or hospitalization. I don't understand the business model. I guess it is just deny deny deny and hope we don't appeal.
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 


Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 11/10/2009 7:32 AM (GMT -7)   
(((FitzyK23))) Sorry for all the run around you got. Sending big hugs your way.
Gail*Nanners* Co-Moderator for Crohns Disease and Anxiety/Panic Forum
Crohn's Disease for over 33 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium  w/Vit D, and Xanax as needed. Resections in 2002 and 2005. Also diagnosed with Fibromyalgia, Osteoarthritis, and Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
It's scary when you start making the same noises As your coffee maker.
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

Sniper
Veteran Member


Date Joined Feb 2004
Total Posts : 6518
   Posted 11/10/2009 7:48 AM (GMT -7)   
Geeeeeez, what a mess. Cant you sue ???? That would be a good idea for all of us if you could. Anyway,,,Big hug((((()))))) and hope it works out soon...Thinking of you...
If we would read the secret history of our enemies,we would find in each mans life sorrow and suffering enough to disarm all hostility.


MMMNAVY
Veteran Member


Date Joined Jul 2006
Total Posts : 6927
   Posted 11/10/2009 7:49 AM (GMT -7)   
a cleaning cost 200 bucks???????????
Forum Co-moderator - Crohn's Disease/Thyroid Disorders:_All comments have the caveat contact your local health care provider.

I will find a way or make one. –Phillip Sidney 1554-1586

All that I am and all that I shall ever be, I owe to my Angel Mother.

The Bucket List- Have you found joy in your life?  Has your life brought joy to others?

Make sure your suffering has meaning…


pillpopper
Regular Member


Date Joined Jan 2009
Total Posts : 209
   Posted 11/10/2009 5:51 PM (GMT -7)   
Fitzy,
You're way stronger then them...
Do not let them get you down...
I used to get frustrated, because I had to prove I had a chronic condition twice a year...
I think the same way as you,I look at things as a business model,and how long can they continue
to stay in business.(and of course I tell them that) confused
Bottom line, I hope you get what you need,and soon...
B-12injections,Pentasa,Loperamide,Entocort,6mp,Hydrochlorothiazide,8 week
Remicade,vitamin-D,Fluconazole.More over the counter vitamin-D. Remission since surgery and 5-years, of 8-week Remicade.
.


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 11/11/2009 3:08 AM (GMT -7)   
Oooh. That's just wrong.

Sorry this is happening, Fitzy.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


xraygrrl
Regular Member


Date Joined Aug 2004
Total Posts : 102
   Posted 11/11/2009 7:05 AM (GMT -7)   
Anytime I have a problem with insurance, I send them a letter telling them if they don't resolve the matter, I'm going to file a complaint with the state board of insurance & I put a cc at the bottom with the board's address (even though I never actually send the cc). Seems to work like a charm.

FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/11/2009 7:05 PM (GMT -7)   
Thanks everyone. I am following the administrative procedures to appeal the protonix issue. If this appeal is denied I will file one more w/ them, then with the state board of insurance and then if that failed I would probably sue. Hopefully it will not come to that.

Navy - when my husband went to the dentist it was the first time after our move and a new facility for us so they took x-rays too. The issue is, when we first moved we were on his insurance and dental. We have since switched to my insurance (same company, better price). Apparently, his old health insurance plan covered one cleaning a year or something and the dental insurance was supplemental for anything over that. So now that he is on different health insurance they think they don't have to pay even though he still has and still pays for the dental insurance. He is fighting it. Also, either way, the dentist later informed him that they don't accept that insurance. They probably should have told him that BEFORE they did the work on him.

On the bright side, I saw an update on my online account that my pentasa prescription (the one they lost and cancelled) is now being filled.
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 


LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 11/12/2009 9:54 AM (GMT -7)   
This made me really angry...I'm so frustrated with insurance companies, and I don't understand how it's legal to prescribe medicine or take it away without a doctor examining you. Even more, I don't understand why a doctor that has been with you for YEARS doesn't lend any credence to the matter.
Diagnosed with Crohn's in May of 2008.
Currently taking: Prednisone, pentasa, omeprazole, and humira. Using probiotics and a multivitamin.
bonniegriffith.blogspot.com/
Learning how to live again.
"He who has a why to live for can bear with almost any how."


jeanneac
Veteran Member


Date Joined Feb 2009
Total Posts : 1812
   Posted 11/12/2009 3:43 PM (GMT -7)   
Do you know that some insurance companies, especially HMO's are paid money to deny claims? I was watching interviews in front of a senate committee from such doctors when people were suing HMO's. These docs clearly admitted, the more people they denied, the more money they made. It should be illegal and if this health care stuff passes, it will be.  So sorry you experienced this!! Just think of people who are elderly, can't read or have other disabilities along with crohn's.  It is impossible for them to navigate the system. I pray they fix it. Get well soon!
diagnosed 1/09 with "diverticular colitis" ?? location: sigmoid colon
localized scleroderma & IBS, low thyroid,claritin, advair, singulair, lisinopril, progesterone, colazal, fish oil, synthroid, zoloft, wellbutrin, VSL#3 probiotic, Vit. D
Blood test positive for Crohn's via prometheus ibd serology panel
 


bookgal77
Regular Member


Date Joined Jul 2009
Total Posts : 83
   Posted 11/12/2009 7:28 PM (GMT -7)   
I'm so sorry you had to go through this. This is the exact reason I am SO scared to ever change jobs. I love my job now, but I'd like to move back to my "home" area eventually. But alas, I feel that I cannot because of getting new doctor's, new insurance, new medication drama...all the stuff you are going through right now.
**32 year old female; Diagnosed with ulcerative colitis in 2001; diagnosis changed to Crohn's disease in 2009 (but still only impacts colon)
**Asacol (4800 mg daily), 6-MP (100 mg daily), Prednisone (10 mg daily...for a few more weeks), Nexium (40 mg daily)
**Previous meds: Colazal (allergic); Flagyl (off and on for rectal inflammation); Rowasa (enemas only when needed); various pain meds (but luckily none lately); iron IV infusions (when hemoglobin gets low)
**Thankfully only two major flare-ups...2001 and 2009. Hoping to have another 8 years in between the next one (sadly, I do know there will be a next one).


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/13/2009 11:32 AM (GMT -7)   
Thanks guys! If this wasn't my health and finances it could almost be a comedy with everything that has gone wrong/ is going wrong.
 
The lost Pentasa finally arrived but instead of being a 90 day supply it was a 20 day supply.  Apparently, that one was the new doctor's offices fault.  They rx'd me 1 pill 4/day instead of 4 pills/4xday.  I'm sure it was just an honest error, but more drama.  They can't just add to what was already sent out.  So, instead, my doctor has to write a new script, write change of dose on it, put the proper dose, and resend it.  I will then get another 90 day/supply -- oh crap I wonder if I will have to pay another copay.  Grrr.  Time to call them back.  That would be $60 for my doctor's error.
 
And, we got a bill from my husband's dentist.  Apparently they already antsy for their money after one week.  That is a whopping $280.
 
No word still on the Protonix appeal.
 
LMills - I agree about them not taking my doctors word.  Part of the problem though is that this is a brand new doctor for me who is relying on the records of a doctor I saw for years in my former state, and then the records from another doctor I saw for years in the state before that.
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/13/2009 11:41 AM (GMT -7)   
Good news. No extra copayment required. So, I will actually get 20 days of meds for free. I guess that is pretty decent of them, if it actually all works out that way. Now just waiting to hear back from the doctors. This bump in the road took 35 minutes of my work day ---
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 


Carnival Huckster
Regular Member


Date Joined Oct 2009
Total Posts : 159
   Posted 11/13/2009 12:03 PM (GMT -7)   
Insurance, like Crohn's, is a royal pain in the @$$. My company spends $600 per month per person on health insurance for employees. That's $2400 per month for a family of 4!!! If something is not done to fix this situation soon in the U.S. it is ultimately the hard working people who end up paying the price in the form of lower salaries and fewer benefits.

+ 34 year old male
+ Crohn's Disease DX in 1997, doc said it was "moderate to severe"
+ Currently taking 9mg entocort and 40mg prozac
+ SCD for past 10 years
+ 4,000 mg MSM, Calcium, Vitamin D, Multivitamin, S. boulardii, Acidophilus
+ Section in lower jejunum is badly strictured (5mm wide opening continues for 10cm!) but otherwise no other problems in bowel
+ No surgeries so far


GDen
Veteran Member


Date Joined May 2009
Total Posts : 703
   Posted 11/13/2009 4:50 PM (GMT -7)   
FitzyK23 said...
That is a whopping $280.

Sorry, but it's funny to hear a lawyer say that. My lawyer charges me almost twice that PER HOUR, and his bills truly are whoppers. Makes me wish I had legal insurance, or socialized legal services, or something.

FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/14/2009 5:07 PM (GMT -7)   
Hey GDen - you must live in a big city and have a real top lawyer! I agree that legal fees are ridiculously high. But, we don't make what we charge. The firm takes a real big cut, trust me. And at least us new lawyers don't charge our own rates. We charge what the firm bills us at. There are some companies out there popping up that are essentially legal insurance (pre-paid legal is one.) Also, you technically have legal insurance by having car insurance or liability insurance on your home or malpractice insurance for your work. If someone got injured on your property and sued you your insurance company would hire and pay for your defense.

While having a debate with someone about socialized medicine they said "couldn't the same be said for legal services" and I said yeah, I think legal services should be more affordable and I wouldn't have a problem with more government oversight (though there actually is a lot through our professional bar associations). Sorry that you are facing legal troubles and having to even employ a lawyer. Hope it goes well.
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 


inflamed
Veteran Member


Date Joined Nov 2005
Total Posts : 1340
   Posted 11/14/2009 7:39 PM (GMT -7)   
Fitzy- I so know what you are going through. I had to fight for months to get a CT covered because I was admitted to the ER at 11ish pm and they did the scan after midnight. New day, so I must have required preapproval. Hours and hours wasted fighting it while at work. I'm so glad I've never had billable hours. Maybe employers should think of the work time wasted fighting crappy insurance policy claims. Too bad they can't afford plans that would make a difference.

I actually pay extra to be on hubby's plan because I've NEVER had to fight with them. My work plan is free, but the aggravation (and poor coverage) is so not worth it.
Mom to a healthy Pentasa baby and pregnant with #2. 5+ years remission, woo hoo!


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 11/15/2009 11:02 AM (GMT -7)   
My hubby's plan and my plan were through the same insurance company so we figured they were the same just different prices... I guess I'll never know.
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 

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