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

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.

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

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

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.

Jenn,

I'm glad you were able to get some antibiotics. Make sure to detox while you are herxing.

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.

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

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.

cbsoapfan,

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

Rose