I just don't understand insurance companies!!!!!!

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 11/4/2009 3:10 PM (GMT -7)   
I'm laid off, single mom, paying for my health insurance, and quickly going broke because of all this medical crap. I was so excited about my new Doc and his plan for me. Then I go to pick up my prescription and find out I'm only ALLOWED to have 20 pills in 30 days according to my plan. I am supposed to take this pill 2 x a day.

What makes me so angry is that they quickly give out scripts to people if they are for depression, anxiety etc... and even the ones that are highly addictive they have no problem giving refill after refill. I can not tell you how many people I know that are addicted to prescription medicine. And I can tell you that 100% aren't addicted to an antibiotic!!!!!!!!

Why won't they give me what I need? It's not a pill that's gonna make me high! UGH I'm so mad! I even cried at the prescription counter. Poor pharmacist felt so bad. There I am with my baby who is of course crying because he wants to run wild through the store and there I am crying because...I hate Lyme.

Then I left my baby's brand new sneaker in the shopping cart. One of them anyway. I was almost home when I remembered and both me and the baby were crying too much to turn around. LOL I almost brushed my teeth with soap this morning, and then burnt myself twice cooking dinner, because I tend to forget that my hands can't pick up a hot pan.

Frustrating that one day you can be so positive and the next day you feel like the world is closing in on you.

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 11/4/2009 4:06 PM (GMT -7)   

Willowrose
Veteran Member


Date Joined Oct 2009
Total Posts : 699
   Posted 11/4/2009 5:01 PM (GMT -7)   
Jenn,

In my view the insurance companies are for-profit opportunists that would always use a loophole not to pay something rather than give the lyme physicians and their patients the benefit of the doubt. They don't know any more than anyone else whether fewer antibiotics are adequate or equivalent to more antibiotics; arguably they know less because how many of them have a LLMD on staff? Even experts in the field struggle with how to treat Lyme. Because Lyme is "controversial" there is latitude for interpretation of treatment protocol. It is a terrible situation for all of us, and as your experience demonstrates, also discriminatory because it is so unevenly applied. Two months into treatment my insurance company has paid for all of my pills and even, so far, the outrageously expensive mepron, but every time I submit a prescription I'm anxious until it is filled because I'm unsure if it will be covered. Never before, with all of the medical problems I've had, was this a concern. As you say, people with all sorts of medical woes, including people with medical problems they brought upon themselves through destructive lifestyle choices, get full coverage for the treatment plan recommended by their physicians. We can not count on that. How can this practice be ethical?

Some things you might try is to appeal the decision within the insurance company. If you have a representative who sold you the policy and they will intervene for you, that can help. Part of the appeal process can include a peer-peer review wherein your physician talks with theirs to convince them of the necessity for the treatment plan he is recommending. You also could appeal to the state's insurance commissioner, though success may depend on how progressive your state's stance is on chronic Lyme.

I hope this is resolved in your favor.

Rose
I have Lyme; it doesn't have me.


JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 11/4/2009 5:59 PM (GMT -7)   
Thanks Rose. This is exactly why i treated everything with herbs and homeopathy before Lyme. I didn't have to deal with Docs or insurance. I actually pay for my insurance through the company that laid me off. It's COBRA. I'm only in my 3rd month of treatment and already running into this? I called the insurance company and the rep said that it was specific to this drug, that I could get the dosage i need in another drug simliar. I guess that's what I'll have to talk to my Doc about tomorrow.

tomorrow is a new day, right?

Willowrose
Veteran Member


Date Joined Oct 2009
Total Posts : 699
   Posted 11/4/2009 6:07 PM (GMT -7)   
Jenn,

That's encouraging. My insurance company will not pay for Celebrex, but they pay for similar drugs. The similar drugs are all hard on the stomach, so if a person has stomach issues, the insurance company requries that they try two of the similar drugs, fail with the medication because of the adverse effects, and then they'll allow the doctor to submit paperwork to request Celebrex (which is easier on the stomach). That seems like a cruel requirement to me. I've failed on one of the similar drugs and I'm not willing to put myself through that again with another in order to qualify ro Celebrex. Grrrr.

Maybe your doctor will tell you that the similar medication is okay. I'll keep my fingers crossed.

I'm with you, the fewer doctors the better, and the more natural the approach the more comfortable I am.

With Lyme, every day is a new day of boundless possibility both to the negative and to the positive. You just never know.

Take care,

Rose
I have Lyme; it doesn't have me.


Harleyrider
Regular Member


Date Joined Sep 2008
Total Posts : 283
   Posted 11/5/2009 8:02 AM (GMT -7)   
JennInPA

There are precription plans you can get on at some pharmacies.
They dont question what the doctor prescribes.

I know Walgreens and CVS Pharmacies have these plans
Wish I could tell you more abot them. I just have family
members whom dont have insurance and they pay little to
nothing for their cripts.

Get the phone book out and call the pharmacies and simply ask
what kind of plans they have for people without insurance even
though you have insurance. They dont have to know you have
insurance. Might make a difference in the cost and what meds
are available....I know it sounds weird but its all a big game to
the insurance companies and the Pharmacy.

You will see, make the call. Have pen and paper ready to write
cuz the amounts will be so different place to place.

Good Luck
 


CajunGrl
Veteran Member


Date Joined Mar 2009
Total Posts : 4717
   Posted 11/5/2009 8:57 AM (GMT -7)   
Jenn,

I'm so sorry you are going through this. When I read your post, it brought tears to my eyes. Please look into the CVS and Walgreens plans. I think Walmart might have one too. Also, in the "sticky" thread, I have links there for programs that help with meds.

Don't get discouraged yet. There has got to be something that can help you.
**You never know how STRONG you are....until being STRONG is the ONLY choice you have**

lymediseasethroughmyeyes.blogspot.com/

Co-Moderator Lyme Disease Forum


JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 11/6/2009 4:55 PM (GMT -7)   
IT was realllly bad Lyme day that day! I went back to my doc and got a new script that my insurance covers. The new drugs are definately making me Herx, last night I couldn't even lift my head up. Just means its working right?!
“You must be the change you wish to see in the world.” -Gandhi


CajunGrl
Veteran Member


Date Joined Mar 2009
Total Posts : 4717
   Posted 11/6/2009 8:10 PM (GMT -7)   
Jenn,

I'm glad you were able to get some antibiotics. Make sure to detox while you are herxing.
**You never know how STRONG you are....until being STRONG is the ONLY choice you have**

lymediseasethroughmyeyes.blogspot.com/

Co-Moderator Lyme Disease Forum


JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 11/7/2009 4:51 AM (GMT -7)   
My Doc suggested waiting on Detoxing. He does want me to detox, but he said first we need to establish what is causing what. So if I am taking new meds and they are making me herx, he wants to mark that. ( I fill in a chart of good days and bad days).

I think he wants me to detox on my good days. The only reason that makes sense to me is because the detoxing might cause a herx. So if the meds aren't causing me to he wants the detox to. That makes sense right?

Maybe I should start a new thread, because I'm wondering if women herx more when on Aunt Flow is in town, thank God she leaves tomorrow! :)
“You must be the change you wish to see in the world.” -Gandhi


CajunGrl
Veteran Member


Date Joined Mar 2009
Total Posts : 4717
   Posted 11/7/2009 6:02 AM (GMT -7)   
Jenn,

Hopefully he doesn't make you wait too long to detox. In my opinion, it is very important for the body to continue functioning right. I understand where he's coming from though.

It is a fact that Lyme Disease symptoms get worse around a womans cycle.
**You never know how STRONG you are....until being STRONG is the ONLY choice you have**

lymediseasethroughmyeyes.blogspot.com/

Co-Moderator Lyme Disease Forum


Deejavu
Veteran Member


Date Joined Aug 2005
Total Posts : 4306
   Posted 11/7/2009 6:31 AM (GMT -7)   
Hi Jenn,
 
I'm really glad you got your medicine, what an ordeal you have been through, I feel so bad for you.
 
As far as detoxing, one of the main reasons to detox is not to feel the strong effects of herxing..   antibiotics or whatever treatment protocol one is using kills the bacteria which turns into toxins.  If those toxins stay inside the body, a person will herx and suffer from joint pains, brain fog, twitches, you name it..  So by detoxing one is getting rid of dead bacteria that causes havoc to one's body...
 
That's the way I always understood it..  
 
There are great books out there about detoxing and lyme disease as well as websites..  Also great books just on detoxing alone. 
 
I hope you feel better,
Denise


It's all about the Immune System mixed with a large dose of Positive Thinking and Daily Detoxing   ~  Pay It Forward!!
 
This song is about my years with chronic lyme since 1995 and being in remission for over 3 years:
 
 


JennInPA
Regular Member


Date Joined Sep 2009
Total Posts : 228
   Posted 11/7/2009 8:47 AM (GMT -7)   
I have done cleanses/detox before Lyme and the "die off" was brutal. I mean the Lyme Herxing I've experience does not compare at all to the die off reaction I've had from cleanses. I guess that's what scares me is that I would get double hit. double hit, does that even make sense? lol

You know what I mean. LOL
“You must be the change you wish to see in the world.” -Gandhi


cbsoapfan
Regular Member


Date Joined Apr 2007
Total Posts : 128
   Posted 11/7/2009 1:08 PM (GMT -7)   
Willowrose,

I had to try SIX other drugs before my insurance would cover the Celebrex. Let's just say I spent most of my time on the toilet. It was NOT pleasant.

+Lyme
Veteran Member


Date Joined Apr 2009
Total Posts : 1304
   Posted 11/7/2009 7:10 PM (GMT -7)   
Jenn, is it possible that either the Dr or the pharm made an error?

My LLMD made a BIG error on my Doxy script. What he wrote was HALF of what he MEANT. At my next visit, he commented on the 'little communication error' w/ the pharm. Oh yeah, right.

You gotta pay attention and call them out on EVERYTHING.
Bit 1972: Acute and chronic tonsillitis, UTI, miscarraige, appendicitis, hypoglycemia,  chronic neck pain w/ crushed vertibrae, chronic severe back pain, mitral valve prolapse, depression, resolution?
 
Bit Mother's Day 2007: Lyme, Babesia microti, hypothyroidism, EBV, HHV6, Parvovirus B19, low adrenals &misc other hormones, depression, anxiety, more of the above.


Kristiana
Regular Member


Date Joined Jun 2009
Total Posts : 22
   Posted 11/7/2009 10:14 PM (GMT -7)   
Jenn,
I'm just finding out about other sources now.  Some through friends in other states, some from doctors, and other's through the very tiny print on commercials.  Wal-mart (as people probably know?) will accept prescriptions for $4.
I think CVS was $12  And they have a very large list near the pharmacy of some of the meds - I saw a lot of the antibiotics I've taken on that list and thought darn, I paid more for mine WITH insurance.  The other thing I want to find for you, is that 2 of the major drug companies are offering to give people who can't afford them, free meds with a prescription.  It says, there is no limit (end point).  I know for sure, one is Astra-Zeneca - I think it's on their website.  My friend uses them for all her meds and I'm in awe of what they have done for her.  I can't remember the other pharmaceutical company.  When I figure it out, I'll send you the link.  So hopefully these are a few more options??
Sorry I can't be of more help
Kristiana
 
idea  

Willowrose
Veteran Member


Date Joined Oct 2009
Total Posts : 699
   Posted 11/8/2009 9:56 AM (GMT -7)   
cbsoapfan,

What a waste - but I am glad that you finally got the prescription you needed.

Rose
I have Lyme; it doesn't have me.


cbsoapfan
Regular Member


Date Joined Apr 2007
Total Posts : 128
   Posted 11/8/2009 5:03 PM (GMT -7)   
Yeah b.c my doctor played the game. ... she gave me three in samples and wrote out for 3 other ones. Told me ... if you call and "tell me" you have issues, I can move on to the next one. She essentially told me I could lie to her since the Celebrex actually worked and she knew that it was the only one that would work in my case. Even then, Celebrex wasn't the miracle drug. It really didn't help that much,but it helped more than the ones that I actually tried.
New Topic Post Reply Printable Version
Forum Information
Currently it is Wednesday, December 13, 2017 11:34 PM (GMT -7)
There are a total of 2,905,188 posts in 318,841 threads.
View Active Threads


Who's Online
This forum has 158204 registered members. Please welcome our newest member, arycqmiu.
246 Guest(s), 3 Registered Member(s) are currently online.  Details
Dimitri71, Scaredy Cat, up4thefight