He phoned the doctor and was able to get a prescription for a similar drug, in a generic form, to be sent to our mail order prescription service. We paid $20 for the 30 day supply. Well, that was $20 down the drain. In just a few days, he noticed his symptoms returning. To say that he was pissed is an understatement, because he can be a bit paranoid about his health (another post in itself). He phoned his doctor's office and asked that they contact our health insurance company regarding the matter.
You knew this wouldn't be simple, right? I've spent the past three weeks going back and forth between the prescription drug service, the insurance company, and the doctor's office, trying to get the matter straightened out. From what I can follow, a new prescription was ordered, but since the drug that didn't work was a 30 day supply, the service wouldn't send out the new prescription. Then I canceled the prescription that didn't work (didn't want it automatically sent and us be charged for something he wouldn't use) and that added to the confusion. Then they said that you can't have two prescriptions for the same drug at one time. Next, they claimed that our credit card on file had expired (it hadn't). The latest? The prescription service says the doctor's office isn't responding - well, we never have a problem contacting them, so I find that to be a line of bull...........meanwhile, Husband's last prescription, filled in November, is dwindling.
I realize that many people have bigger health problems than this, but it is soooo frustrating. For every step forward, there are three steps backwards. While I'm happy that my adult children (for the time being) are covered until age 26, my mammograms are no longer covered under our health insurance. It's infuriating.
Phew, sounds like a bureaucratic nightmare. Very glad I live in the UK, for all the flaws in the NHS (and there are many). At least I don't have endless tussles over getting a prescription.
ReplyDeleteBut we have the same problem here over the assumption that generic drugs work just the same way as the originals. Which usually they don't because they're formulated quite differently.
OMG, can I just tell you that my mother is going through something VERY similar to what you just shared. And it's driving her crazy. In fact, she's not only experiencing this with her prescriptions, but also her doctor, just like you. She truly needs to find a new doctor because the one she has is totally useless.
ReplyDelete"For every step forward, there are three steps backwards."
Yes, I can imagine how frustrating this must be for you and your husband.
Sure hope this all gets resolved soon, my friend!
P.S. LOVED your post title. It's perfect!
I have noticed, with regard to medical insurance more generally, that it has become a kind of game to push the magic buttons to get them to cover what they say they're covering. . .
ReplyDeleteBut yeah, prescription drug coverage is a special corner of Hell. The rule of thumb is, when you have to deal with two other entities (eg, the insurer and the doctor's office), it is virtually given that, at some point, they will be blaming each other.
It's even more fun when you're trying to get meds for, oh, say, five or six children. . .
OMG, by an odd coincidence I've just left a rather long comment on Portia's blog about this very thing - hang on, I'm gonna' copy and paste what I left in there.
ReplyDeleteI was responding to her believe our UK National Health System doesn't work. From what I gather from other systems, I wouldn't swap ours for the world - I am afraid this post of yours tends to strengthen my belief. I am so sorry your hubby is having to do battle with such an obviously incompetent health insurance company, I sure hope he gets the right meds soon, I can't imagine how frustating he must find all this!
Here is my reply to Portia (you can find her in my comment section):
I do disagree with your view on our NHS, though. You are right in that it can't provide everything, but for the most part it does give a decent care to most (including surgeries, of which I've had my share). There is never any question of this care being cut off because an insurance company deems it too expensive, nor do I know of anyone having to go into debt to receive treatment for their ill-health. All pregnant mother's recieve advice and care from conception through to birth - no children are charged a penny for the medications they may need, and even dental care is heavily subsidised (and totally free to the under 16's, or 18's, if they are students). No one fears facing a bill to visit a doctor, and on a personal note, my disabled son has seen many top specialists in their fields, all courtesy of the National Health System - and recieved endless essential therapies (speech, occupational and physio) the costs of which would have most certainly put us by now near the poor house! As his is a lifetime condition, I have no worries of his funding being turned down as not a cost effective subject for insurer's to cover. I do believe in private health insurance, and have it too, to cover myself if I perhaps choose to jump the queue for something our system considers less urgent to treat. The bottom line is, the cost of supporting this health system of ours ensures NO-ONE is denied the care they need when they are at their most vulnerable. I would never want to exchange that for the healthcare system of the USA.
(Sorry for being so long-winded!)
Your pain is our pain. We have been in constant fights with the insurance company about what they cover vs. what they claim they cover. Our eldest brat has had health issues for near 2 years and this is costing more than the first year when we had NO insurance. Kinda difficult when my share of the monthly premium is $900. Not much left after that.
ReplyDeleteNick - I've been on a generic for years, with no problem. I don't understand the chemistry behind all of it, but I've definitely heard from enough people to realize there is some truth to them not always working.
ReplyDeleteRon - Sometimes I write these posts just to hear that someone else is having the EXACT same issue! Because I know it can't be just me!
Craig - Aint that the truth? They claim to cover something, but then, you get the bill and see that nope, it's not covered. Then they blame the doctor's office for 'coding it wrong.' So you call the dr., and they claim that's how they've ALWAYS coded it, putting the onus back on the insurance company. The cycle never ends, until the patient eventually gives up and pays up.
Shrinky - Thanks for posting! It's interesting because I hear very conflicting stories about NHS. The negative is always that they have to wait months to get an appt. to see a specialist. But then I hear from people like you who are really helped by it.
X - Premiums seem to be skyrocketing. People forget that the money for Obamacare and some of the other additions being made has to come from somewhere. And it's not going to be from taxing the 1%.
we went through the same thing a few years ago when our asthma inhalers were all reformulated due to new EPA regs for flourocarbons. it made all the generics suddenly proprietary but we were supposed to use the cheapest inhaler (a whole$5 cheaper..whoopie!...but it did not work) it took 6 months and boiled down to me threatening to take my son to the ER every time he so much as wheezed if they didn't approve the drug that worked. you wanna pay $5 more for the inhaler or $500 more for an ER visit?
ReplyDeleteIt's crazy. My insurance doesn't cover prescriptions at all. AT ALL.
ReplyDeleteIt's infuriating. The other thing that our carrier likes to do, is to either call or email, or otherwise interrupt my life, to tell me how we should be using this "equivalent" drug.
ReplyDeleteNOT a generic, but one that is supposed to be "as effective" for whatever... despite the fact that it's not actually listed and approved for the use, it's that much cheaper (for them, not for ME, though).
Oh, and the calls, "You are paying more by using the retail pharmacy for this ongoing prescription."
Huh? I pay $2.00 by getting that one locally, compared to the $20.00 the mail-order would cost. WTF??
sorry, didn't mean to take over with a rant, but gaaah, I hear ya on this one!
Lime - I LOVE your response to them. Sometimes threats is all you have left to work with.
ReplyDeleteAgent - That is some really bad insurance. I know the self employed have much, much higher premiums and fewer benefits. That is lousy!
Sailor - Rant away! I can't imagine being constantly pestered by my insurance company.
Shrinky's description of the NHS is very accurate. The only drawbacks I can think of right now are increasing waiting times for surgery, hospitals prone to superbugs like MRSA, and higher death rates over the weekends when hospitals aren't properly staffed. But overall the NHS is a fantastic system.
ReplyDeleteI had a dental filling recently, which cost me £13.44 ($21)!
Well that's a real mess. I hope it gets resolved soon. Seems like it's a common problem though, unfortunately. I've heard from others that they have had issues and we've even experienced a few things too. I become very anemic sometimes and need extra iron. If you've ever taken otc supplements like that, you might know they can be harsh. One of my docs years ago put me on a prescription that came in liquid gel cap form but because it was considered a 'vitamin' the insurance wouldn't pay for it. They would pay for the doctor visit to evaluate the condition, and a specialist visit if necessary, and they would even pay if I ended up in the hospital having blood transfusions, but the actual thing that would help prevent me from having to use all that insurance money was the one thing NOT covered. Amazing.
ReplyDeleteI also am on a maintenance drug that we have to get mail-order now every 3 months but before they would cover their share I also had to try the generic, which did not work for me. Luckily, the other med was made available to me again without much hassle. And also, since I see a specialist for the condition, I'm able to get samples.
This sounds like it is getting out of control. I gotta say I havent had to deal with this hassle just yet as I am only 23 and am covered under my parents insurance mostly to save me money. However the time is fast approaching and stories like this make me afraid to have to go through it!
ReplyDeleteNick - Thanks for stopping back to confirm Shrinky!
ReplyDeleteChick - It is indeed maddening. The insurance companies talk a good game about prevention, but they don't want to pay for it. Everything is ass backwards!
Vie - Speaking of adult children on a family plan, I've been getting all sorts of hassles when I call about my 19 year old because of these confidentiality clauses. I'm like, "Ok, she has autism, shall I put her on the phone?" and then they back off! But seriously, WHAT college age kid has a clue about what they need to do in regards to their insurance?
The "coding it wrong" issue is a mess. I have just begun talking to the insurance company until they tell me exactly what is coded wrong and how it would need to be coded to get it covered. Then I call the doctor back and tell them that if they want me to get it paid, they need to recode it THIS way, regardless of how they always code it.
ReplyDeleteBut now with a $3000 deductible, I know I'll be paying for most everything on my own anyway. Good times. This is why I vetoed the idea of a colonoscopy.