Insurance Company @#%$%@#!!

[kadi]

Ok, so I knew my instillation meds appeal would run out (one year only) in July and I knew my doctor was going out of country for 3 months, so in June, I prepared all the appeal paperwork, set it up for my doctor to resend the letter he's sent every year for the last 5 years, got the price quote from the pharmacy etc. Same process as the last 5 years. In June, it all gets sent in, I get a phone call from the insurance company saying my medicine is approved until 2012. I'm happy & think it's done.

Then this week, I get a letter from insurance saying the bupivacaine appeal has stopped because my doctor hasn't responded to a request for information and my coverage for the medicine will be denied if the doctor doesn't respond in 45 days. Thursday, I call my doctor's office & leave a message on the nurse's direct line to please call the insurance company & give them the information they need or the medicine will be denied. Today I called the insurance company to see if the doctor's office called and instead I'm told that the medicine is already denied and I should start the appeal process and she'll mail me a form. I lost it and screamed at the woman on the phone. I told her we'd already mailed an appeal form, a letter from me, a letter from my doctor detailing all the treatments I've failed & why this medicine is necessary. She just keeps saying my doctor did not return their phone call on June 24th, so the medicine was denied July 6.

Well, neither June 24th or July 6th was 45 days ago and I only got a letter this week, so nothing should have been denied yet. She then tells me she can reopen the case file for me, puts me on hold with bad music, and then comes back on to tell me she actually can't do anything and that I need to call back on Monday and to call such-and-such number - which was exactly the number I called today, which said in the letter was open 7 days a week, 24 hours a day.

I'm so frustrated!!! I guess I can photocopy all the stuff we sent them in June and resend it if they really have denied the medicine, but I'm also considering finding out how to file a grievance. This is pure harassment - I've had to go through this every summer for the past 5 years for the sodium bicarbonate & bupivacaine. Every single year we send letters to the insurance company saying that I've failed all other treatments except these home instillations, that I desperately need the medicines to work and function, and every year insurance demands more phone calls, drag their feet, and after multiple attempts by me and my doctor, agree to pay for one year exactly.

And if that all wasn't frustrating enough, the same insurance company two weeks ago delayed shipment of my heparin (a medicine that has never needed an appeal) because the pharmacist, "didn't know what it's used for and the doctor hasn't called back." Um, I've been getting this medicine for five years from them, and all of a sudden, they do this and don't even call me to let me know there's a question?!! I explained bladder instillations to her and told her that the appeal letter spells out exactly how and why I use it. So, now I'm delayed in getting this medicine too.

How many people's jobs do I have to do? I already have a job!!! Dealing with IC itself feels like another part-time job. Add the insurance company and then it's even more!!!

Monday I'll call my primary care doctor (who is not out of country) and ask his nurse for help. She's very good about answering calls and can maybe either take care of calling insurance herself or maybe she can talk to the substitutes in the urologist's office. My calling seems to have fallen on deaf ears.

@#$%@#$%!

[ICNDonna]

I hope you can get your instillation supplies approved soon. I know they're expensive.


Donna

[kadi]

This doesn't feel like a bureaucratic snafu - this feels like harassment. It feels deliberate and it's hard not to be furious. I gave them everything they needed in advance and they're giving me and my doctor a run-around. I pay over $600 a month out of pocket for health insurance, which is a lot of money to be treated like this

[nottoc4]

I don't know how they get away with this. Can you contact your State Insurance Commissioner to make a complaint? Insurance companies get away with murder sometimes.

[L. Thomas]

I'm so frustrated!!! I guess I can photocopy all the stuff we sent them in June and resend it if they really have denied the medicine, but I'm also considering finding out how to file a grievance.

I have always had problems when communicating with insurance companies unless I send the letter registered mail, return receipt requested. This way you can be sure they got the letter and you have written record of who signed for the letter.

[kadi]

Unfortunately, now the insurance company is saying they did get the letters, but they want to talk to the doctor in person. My doctor is out of the country for the next 3 months and his nurse who usually helps me, just had surgery & is out for at least a month. The other urology nurses & doctor are not returning my phone calls.

My next step is that if no one has called insurance by Friday, I'm going to call & schedule an appointment so I can hand them the phone & we can call insurance together! The insurance company has moved my case up to a supervisor who at least sounded reasonable and if we can just get my doctor on the phone - it should be resolved. I'm just aggravated at how my doctor's office isn't calling back. Just because my doctor is on vacation doesn't mean my IC took one!!!

I was mad enough to say on the phone yesterday that I have a hard enough time working a fulltime job (I started a new job yesterday) dealing with my IC symptoms alone is another part time job, and now dealing with the insurance company is like having a third job. Could the doctor's office PLEASE call insurance and call me back so I can take this $%^&**@# off my to-do list!!!

[bubbe1]

insruance company

Kadi,
I'm so sorry you're being tortured by your insurance company. I know what that's like. My hmo can drive me nuts!
I hope you can get the whole mess straightened out. Is there, by any chance, another doctor on your doctor's team who might be able to step in and help in your PCP's absence?
Please let us know how this works out.
Laurie

[kadi]

The nurse called me today & told me she is totally frustrated because she says she's faxed the company the information now 3 times and they told her today that I had no appeal pending. We agreed we'd both start documenting names of reps and times of calls and if it's not solved by Wednesday next week, we'd set up an appointment for me to come into the office and make a conference call to the ins company. Somebody is not telling the truth, I think the insurance company probably. Donna suggested I also send the information in to the company via certified /signature of receipt mail.
Fortunately, I have enough medicine to get me through for awhile... Ugh.

[bubbe1]

insurance compny

Good luck, Kadi.

[kadi]

Ok, today the rep told me that the doctor still hasn't sent in the information, so I asked for a supervisor and she told me in the same conversation that:
a) The medicine is not really denied, they're just waiting for the doctor to contact them.
b) The medicine is denied because the doctor didn't contact them.
c) The medicine is denied because my plan doesn't cover it.
d) That I should start an appeal because she can't help me
When I explained that all of this issue started when I filed the appeal and that I've been told that two of the three medicines listed in my appeal have now been covered, she told me that I need to call a different office on Monday because even though the letter her company sent me says to call 24/7 including holidays, the office I need isn't open.

AAAAAGGGGGHHHHHHH. I managed not to cry or swear on the phone, but I'm angry and frustrated beyond belief. I'm now taking names and numbers every time I call and documenting it all. I guess I'll be making a doctor's appointment, a conference call with all of us on the phone and following up with a certified mail letter requiring signature.

I hate this!!! I already pay $600 a month premium and about $250 more in copays per month, and that's if nothing goes wrong besides my IC...

[curlycue]

Meds

Kadi........ is this the medication you get from Parsons? I am really sorry you are going through that.

[kadi]

Hi Ruth,
I don't see Dr. Parsons (though if I lived near San Diego, I'd like to - we heard him at that great conference we went to in 2005!), but it is one of my instillation medicines. I use bupivacaine (for me - lidocaine burned & didn't work as well), sodium bicarbonate, sterile water & heparin. I can't believe the hassle the insurance company is giving me over a medicine that I've used and purchased through them for years! I have to appeal every summer for coverage, and it usually takes the initial appeal and then one additional doctor contact.

My mom told me today that my insurance company was recently bought by another, so am wondering if there's some new profit-margin increasing policy going on behind the scenes?

[curlycue]

Medication and the cost

Hey Kadi

I was in to see Parsons on 7/19/11 and he is having a pharmacy company compound the meds he gives out and I have to tell you it works GREAT but like you stated the cost is unbelievable I paid 360.00 for a months worth but I pay for all kinds of other meds as well? Good luck with that I know how frustrating it can get.

[SFGirl]

Kadi, I am so sorry this is happening. I completely understand your frustration...dealing with insurance completely is a nightmare!! Even with insurance, my out-of-pocket expense is in the thousands each month


I want to wish you lots of luck in sorting this out. *Hugs!*

[kadi]

Latest development. I requested a supervisor to help with the case. The supervisor told me she'd call the nurse at my doctor's office herself and connected the nurse with the pharmacist for the review. The pharmacist asked the nurse how I use the medicine and then told her that she was denying the request for the medicine as my insurance doesn't cover home medical treatments. Uh, but they approved the heparin, the sodium bicarbonate, and the sterile water which I instill at the same time as the bupivacaine? We didn't press that point then because I was afraid they'd start denying those too!

So, the nurse asked to be reconnected to the supervisor who told her that there was nothing she could do because now the pharmacist has denied the medicine and the case is now closed. She asked what to do now and the supervisor told her to file an appeal. (Which is what we'd already done!) So, the nurse & I agreed that she'd re-fax the appeal paperwork from June 22nd and try again. If they claim to have not received it, I'll send it certified by mail along with the fax receipt.

I wonder if they're just stalling because the company was bought out and will no longer be my prescription coverage after January...

I've given up being furious, now I'm just tired. I just started a new and very demanding job two weeks ago and can't afford to be that angry.