Insurance Company @#%$%@#!!

[bubbe1]

insurance company

Kadi,
Great news!! At last!
Be well,
Laurie

[kadi]

It's finally approved. We resubmitted the appeal paperwork (faxed the exact same letters again.) I got a call today from the computer and it's approved til August 2012. I didn't believe it, so I called & verified it with a representative and it's now finally done. I don't know why they had to put me through 6 weeks of hassle over it, but whatever. It's finished and I'm glad not to deal with it again. Fortunately or unfortunately, my insurance will change in January to a different mail order pharmacy service, so we'll see how that goes, if I have to do this again.

[bubbe1]

insurance companies

SF,
I couldn't have said it better myself.
After a while, it just gets so exhausting to fight with these companies.
Finding an advocacy organization is a very good idea, though.

[SFGirl]

That makes me so mad!

When people make decisions about denying coverage, do they not realize that they are directly affecting the welfare and quality of life of another person?!?!

I am also so tired. So tired of all this bs and hoops that need to be jumped through just to get some treatment. So tired of having treatment denied after its been approved.

This is ridiculous.

If you get much to tired to continue dealing with this, there are advocacy organizations that might be able to help.

Good luck and you are in the my thoughts!

[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.

[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!*

[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.

[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]

Meds

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

[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...

[bubbe1]

insurance compny

Good luck, Kadi.

[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]

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]

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!!!

[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.