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).