Today I experienced what I am sure many others have experienced; prescription denial. It was my first time. I was shocked. The anti nausea drug that my oncologist had prescribed for me, which I might add, I had successfully filled five times previously, was summarily denied by my prescription drug insurance company for some reason. The clinic had warned me initially that the drug was very expensive and they might deny it, but that they could usually get an authorization if needed.
I didn't need it.
Five times.
Now nothing.
Since I was getting my chemo treatment today and I had plenty of time, I called the insurance company myself. After going through a couple of menus and a couple of different people, I finally ended up with someone who could help me. It turns out that the brand name drug is covered, but the pharmacy had submitted the generic. This seemed odd, but who am I to argue. We ended up with me agreeing to ask the pharmacy to try it under the brand name. OK. I called the pharmacy, explained the situation and had them try again. Sure enough this time it went through. So everything is OK right?
Wrong!
It went through all right. At six times the copay as before. I told the pharmacy not to fill it because I certainly wasn't going to pay $120 for six pills. Not without more investigation. I can really feel the pain of people without insurance. If I had nothing, the cost would have been over $400. For six pills. You should see my monthly benefits statements for the chemotherapy. Thousands and thousands of dollars. I am very thankful to have relatively good health insurance. I can't imagine the impact on noninsured people. It must make their diseases that much harder to bear. I really think healthcare should be the top issue in this election year. Something has to be done to make sure that people get the care they need without going broke or worse, not getting the care they need.
In the meantime, its back to the phones to try and figure out my prescription. At least I have someone to call.
I didn't need it.
Five times.
Now nothing.
Since I was getting my chemo treatment today and I had plenty of time, I called the insurance company myself. After going through a couple of menus and a couple of different people, I finally ended up with someone who could help me. It turns out that the brand name drug is covered, but the pharmacy had submitted the generic. This seemed odd, but who am I to argue. We ended up with me agreeing to ask the pharmacy to try it under the brand name. OK. I called the pharmacy, explained the situation and had them try again. Sure enough this time it went through. So everything is OK right?
Wrong!
It went through all right. At six times the copay as before. I told the pharmacy not to fill it because I certainly wasn't going to pay $120 for six pills. Not without more investigation. I can really feel the pain of people without insurance. If I had nothing, the cost would have been over $400. For six pills. You should see my monthly benefits statements for the chemotherapy. Thousands and thousands of dollars. I am very thankful to have relatively good health insurance. I can't imagine the impact on noninsured people. It must make their diseases that much harder to bear. I really think healthcare should be the top issue in this election year. Something has to be done to make sure that people get the care they need without going broke or worse, not getting the care they need.
In the meantime, its back to the phones to try and figure out my prescription. At least I have someone to call.
3 comments:
I hates them. Yes, I does.
I especially hates that they are "good".
I already told Meg:
I think health care is governed by rabid Calvinists that apparently believe that those who suffer earthly ailments DESERVE them for being naughty. So of course one should suffer MORE...
Oy.
Ick.
And so true. I was discussing health care issues with a doctor-friend here just yesterday. Having to deal with insurance companies sucks. NOT having any insurance company with which to deal sucks even more.
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