Friday, June 27, 2008

when will it end!

ok, first off, i want to thank those who tried to help with my mom's insurance thing. apparently, she'd been paying for herself AND my dad (who's been gone for 7 years). the insurance company wants us to send in a copy of my dad's death certificate, a letter explaining why we didn't do anything about the insurance, and a letter asking for it to be cancelled. They won't refund her money for herself, but they will refund for my dad. oy vey.

now, for my own insurance woes. Sean is on high doses of medication. as such, the insurance company we now have covering prescriptions requires prior authorization for 2 of his medications. here's where the fun begins. i didn't know about the whole prior authorization need until i took in a prescription, and the insurance refused to give me the whole amount (120 pills). then we got to wrestle around with it for a week and a half, and have the doctor's office talk to the insurance company, and the insurance company take FOREVER to get the prior authorization in place before they would give me the other 30 pills. (the insurance believes he only needs 3 pills a day, as opposed to myself and his doctor thinking he needs 4. needless to say, the thought that an insurance company can dictate how my son is treated, as opposed to me & his doctor? infuriating as hell). fortunately, in this case, we were able to do it without my having to pay a second copay.

fast forward a month. sean also takes adhd medication, which is a controlled substance. for his age, he takes a pretty hefty dose. this medication, as well, needs a prior authorization. when the doctor's office failed to mail this month's prescription to me, i ended up not getting it until i only had pills for a few days (4 to be exact). i took the prescription in on friday afternoon 2 weeks ago, and picked it up after 5. or tried to anyway. the prior authorization had expired. nobody knew why, it shouldn't have, because this insurance company took over april first, and prior authorizations are for 6 or 12 months. this is only mid june, folks. so they refused to fill the prescription. the insurance company refused to talk to the pharmacist about it, because it was after 5 on friday, and their prior authorization department was already closed. so was the doctor's office. so, the pharmacist told me she would fax the necessary info to the doctor's office for the PA, and would work on it monday & tuesday. tuesday night comes, still no PA, and i'm now out of pills.

if you've ever dealt with an ADHD child who really needs medication (not all of them do, but some need it desperately), you know that every parent absolutely quails at the thought of no medication. we don't even scale back in the summer, because he needs it ALL THE TIME. so, i was forced to take the 30 pills that they would give me without PA, so that he would have medication for the next few days while everything got straightened out. the pharmacy, doctor's office AND insurance all told me that i would need to get another 30-pill prescription to make up for the one the pharmacy had to alter in order to get me medication.

once again, the doctor's office fails to mail my prescription, even though i talked to the secretary, and verified that they had the correct address. fast forward to this morning. i dropped off the prescription, and asked them to call me if it didn't go through. at 11, i got the call saying it wasn't going to go through. so i called the insurance. after being on hold for something like 20 minutes while they wrangled all this, they finally got it to go through (apparently, the system was treating it as a new scrip, and i was filling it too soon (i understand trying to keep a tight control on medication like this (people steal them to get high with), but this is driving me nuts!). however, they were going to make me pay another copay, even though it was just finishing filling out the previous prescription, because it had a different scrip # (controlled substances are written out on numbered scrip pads, and monitored by whatever agency takes care of it, to make sure the doctor isn't giving out too many to too many people). the pharmacy did say that i could probably call the insurance and explain the situation, and they'd reimburse me for the $30, as i'm really not supposed to be paying double like that.

i call the insurance company and find out 2 things: 1) the prior authorization had NEVER EXPIRED. she doesn't know why it showed up as such. it's good through october. this crap should never have taken place in the first place. 2) in order to get my $30 back, i have to cancel the 30-pill prescription i just took in this morning, and get a new 60-pill prescription from the doctor. and because mark hasn't logged in to the insurance website since they switched, i don't know passwords or anything to get into it, so they're mailing a form to me, so that i can get my $30 back.

and when i complained back 2 weeks ago? the insurance company said i needed to take it to the insurance holder, i.e. mark's employer. mark didn't want to do it because "i'd waited too long to get the prescription." WTF? i had called the prescription request in to the doctor's office when sean had a 10 day supply. i can't call it in much earlier than that. i did what i'm supposed to do. the doctor's office failed to mail t he scrip when i had asked for it. we are having a serious talk tonight, and if he doesn't go talk to hr or benefits or whomever he needs to speak to about this, there are going to be problems. i should not have to go through this EVERY FUCKING MONTH.

small wonder i have a headache, eh?

5 comments:

Simply me said...

I'm sorry you are having such troubles with this. Insurance companies make me so angry sometimes.

Snarled Yarns said...

Truly!

Ina said...

That is just obscene. I hope things start working the way they're supposed to work!

It might be worthwhile for Mark to tell his HR department that you've been making a good faith effort to follow proper procedure, but are encountering difficulty. It's important feedback on the health plan - a matter of information rather than a complaint.

Anonymous said...

yes you have quite a headache there, but look on the bright side, at least you have insurance, for those of us who can not afford insurance, the headache is medications or food/rent/heating...

Lynne said...

It's not easy dealing with all this...
I just heard that there was a(t lesatone) tornado in Omaha. You weren't affected? Or maybe you were cos you haven't blogged recently... hope not!