Just a rant about insurance

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.

(((FitzyK23))) Sorry for all the run around you got. Sending big hugs your way.

a cleaning cost 200 bucks???????????

Oooh. That's just wrong.

Sorry this is happening, Fitzy.

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.

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!

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.

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.

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.

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.