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Quarreled with my GI

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Crohn's Disease
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Posted 8/21/2013 5:48 PM (GMT 0)
Saw my GI finally today as he was not available for many weeks. The abdominal mass I had in my left side turned out to be severe distention. The problem arose when I told him that the insurance company does not want to give the quantity of Nexium I need every month as they think that taking 80 mg of Nexium/ day is too much. I asked him to negotiate the matter w them but he refused. He said I should not justify the doses I prescribe. I told him I won't take my meds but he didn't want to talk about it. I felt he was caring about his ego and did not want to help. So, I was in a rage and ended my visit and left.
If doctors have a problem together, why should the patient be the scapegoat? I felt very much humiliated.
Thank you for listening.
Posted 8/21/2013 7:10 PM (GMT 0)
Wow! What was the doctor expecting you to do??? I'd be pretty angry too. See if his office nurse will advocate with the insurance company for you. He seems like one of those types that is too high and mighty to be bothered with calling insurance companies. That is a really high dose though...haven't heard of that before. Maybe Habs will come along...she's our American insurance expert (Habs...you have a new role) and maybe she'll have some advice for you. I know you aren't in the US, so maybe that won't help
Posted 8/21/2013 7:18 PM (GMT 0)
I recently had a problem with my insurance company refusing to fill a prescription my doctor had written.

Your doctor needed to work with you and the insurance company. it does sound like a pride thing, or anger at the interference of the insurance company. In other, misdirected at you.

I would be angry as well. He might not want to do it, but it is within his responsibilities, to his patient.
Posted 8/21/2013 7:25 PM (GMT 0)
Gumby, thank you very much. Yes, he is. I negotiated this dose w him before and he said I have NERD (non-erosive reflux disease) that necessitates doubling the dose.
I need still to listen to Hab's pieces of advice. I feel I'm begging and decided to try to cope w my disease as much as possible and not to see him regularly though this distention was causing me the loss of appetite I have been suffering from for a long time. After I had taken the meds he prescribed today, things became better and I could have some bites of food.
Take care :)
Posted 8/21/2013 7:31 PM (GMT 0)
Myself 09, thank you very much. Hope your problem had been solved. Yes, I think it's a matter of pride.
Take care :)
Posted 8/21/2013 7:35 PM (GMT 0)
Here's a Nexium link to a discount.

https://www.purplepill.com/purple-plus-savings-card.aspx it may only cost you $18 a month

T
Posted 8/21/2013 7:38 PM (GMT 0)
It took three days and lots of phone calls, but it finally got dealt with.

AND, it took ,my doctor's office to finally broker a compromise. Call the nurse, or office manager. Your doctor NEEDS to be held responsible for his patient. Sheesh, I sound militant, but I do get miffed.
Posted 8/21/2013 8:25 PM (GMT 0)
QuestionEverything, thank you very much. I really appreciate it but I'm not a US resident.
Posted 8/21/2013 9:43 PM (GMT 0)
Wow, that's ridiculous! I've had to have doctors go to bat with the insurance companies before, and they are always eager and ready to do so. You were right to be so upset.
Posted 8/22/2013 12:16 AM (GMT 0)
Seems like the universal agreement is your GI was in the wrong, and I agree with them. In the UK, you can quite often run into prescribing problems, due to incompetence as much as anything else. But sometimes there can be disagreements over funding, eg the hospital says your GP should prescribe this expensive med, and vice versa. I had a lot of difficulty getting funding for Humira, but my IBD nurse fought that particular battle on my behalf.

In your case, the GI would undoubtedly have more sway with the insurance company than you do. His reaction sounded really pompous: it's not about 'justifying' his prescriptions, it's about ensuring his patients continue to get the meds they need.

I hope you continue to get the Nexium. I'm sure you will, but it will be a tedious battle that nobody with a chronic illness needs.
Posted 8/22/2013 7:58 PM (GMT 0)
Jen77 and NCOT, thank you very much. I decided to try to cope w my disease and to fight for my battle whether he backs me up or not. This is not a cause to change him but I'm going not to see him on a regular basis as I used to do before. This quarrel affected me psychologically and made me feel sorry for myself. His turning me down was very shocking for me esp. that he knows that he has to support me in my battle w the insurance company and he preferred his ego over his patient's benefit esp. that I have been following w him for almost seven years now.
Posted 8/23/2013 11:28 AM (GMT 0)
Well my first day on the job and I’m already late!   Thanks for the recommendation Gumby! First I have to say your doc is a dufus (nicest word I had at the moment).   He is supposed to be your advocate, not you being his toy.   I would say to ask the nurse in the office if a rebuttal to the insurance could be drafted.   However, I am suspect that if she did do it, it still would not get past the doc to sign it. I am speaking in terms of what works in the US so I don’t know if that will help.   Call your insurance company and ask to speak to a Nurse Case Manager.   Don’t speak to claims or billing.   You want the Case Management team and preferably a RN.   The nurses at insurance companies are usually pretty understanding and empathetic.   Explain to the nurse that your doctor is not advocating for you so you were calling to see if you could have the claim denial reviewed by Case Management and/or the Medical Consultant.   Explain:   other similar meds that you have tried that failed, lesser dosages of this med that failed, other treatments that failed.   Explain that you are not receiving the med just for GERD, but that it is related to your CD/UC.   Basically, you are giving all the medical reasons that justify your need.   If you happen to have any notes from the med website that show your dosage as an option, even better.   Stay away from emotional explanation (hard to do for me---the nurse may be so understanding that you may get into emotional well-being too though.)   If she passes this up to the medical consultant, he may call your doc—docs will talk to other docs usually. Document the name of the person you talked to and ask that they follow up with you on it, preferably with a letter so you have paper documentation.   For your sake, I hope you can consider another doctor.   And I hope things improve soon!
Posted 8/23/2013 2:51 PM (GMT 0)
You're 10 minutes late, Habs - lol. Thank you very much. Though it's not the same system here but I'll follow your procedures in the negotiation process particularly that part regarding showing that I need this dose based on medical evidence. I'll fight my own battle and hope that I get the Nexium I need at the end.
Posted 8/24/2013 3:00 AM (GMT 0)
The GI I have now is my 3rd. The 2nd one I had because of a move. But he was very rude to me so that was the last time he heard of me.

I hope you can either clarify this with him or find another GI.

All the best for you.
Posted 8/24/2013 1:32 PM (GMT 0)
Andrina, thank you very much. I'll wait and see how things go on. The most important thing was that he left me quarrel w him and he was very calm and indifferent; which made me more angry. I still can't get back to him though I'm suffering.
Take care :)
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