Thursday, January 30, 2014

My Lupron Insurance Battle

Remember how back in November I mentioned I was having issues with the pharmacy filling my Lupron prescription?  No? Here is a link if you want the details, but basically the doctor had called it in to the pharmacy in September, and it took them TWO MONTHS to get the thing approved.  Which was annoying, but I figured it was worth it to know I was approved, right?   But there was a snag. I had my injections in November and December, and low and behold, the insurance company denied both of the claims.  DENIED.  And they were ONE THOUSAND DOLLARS EACH.


So what the two month preapproval hold up was about we will never know.

But anyway, when I got the second denial I once again called the pharmacy to basically say, "WTF" to which they replied "we are working on it..." and "any day now it will be approved..." .  After awhile I got annoyed with the pharmacy and went directly to my insurance company, thinking I could cut out the middle man.  I called the insurance company for the first time on January 6th, but they were closed for cold weather.  Fine.  I called again.  A lot.  I would venture to say I have called at least 15 times during the month of January.  Do you know how much time I have wasted on hold with these people??  TOO MUCH.

So day after day, as weeks begin to roll by, I am waiting for these injections to be approved.  My doctor faxes my records on the 8th of January, so now over three weeks they have had these records either in imaging or under review.  I was suppose to take my next injection on January 14th.  It came and went with no approval of the previous injections and no preauthorization for the four more I need. 

Nobody has answers.  There is supposedly nobody I can talk to at the Insurance company, they say nothing can be done to speed up the process.  Just keep waiting.  Meanwhile my endo has starting kicking back in, causing so much pain and discomfort it makes me cry to even try to talk about it.  And I am getting more and more angry.  How is this fair?  I feel AWFUL, and yet I can't take the medication I need, which the doctor has prescribed, because my INSURANCE company can't decide if it's necessary.  Really?  But they paid for my surgery for this same condition, no questions asked.  It makes no since.

Except for the fact that it will cost them thousands of dollars.  And they are a business after all.

As of today I am over two weeks late on my next injection.  I was up all night miserable. I am so angry.  I called my doctor and they are getting involved in the fight, plus they had a sample of the medicine they offered to give me today.  I went right over and got it.  I hope it makes me feel better soon.  And I hope they can help kick my insurance company into gear before another four weeks slips by.  You would think that would be plenty of time, but this has been a problem since September.... the system is broken, and I am suffering.  Literally.


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