The doctor-medication-insurance run-around

I have been trying to refill my prescription for more than 3 weeks, and now I won’t have it when I need it, by Tuesday.

I have been on this prescription for a long time, around 7 or 8 years, and it works.  It’s a hormone, and it’s not a life-saving Prescriptiondrug, but it sure does make my life better, especially for several days a month.  For various reasons, I went off of this drug twice in recent years, and each time, I had bad PMS symptoms.  The moodiness was really horrible.  Plus I didn’t get a period.  It’s obvious my body reacts better when I am on this drug.

When I started this drug, my insurance covered it with a $40 copay.  Later, it was covered with a $10 copay.  Now, it may or may not be covered.  They haven’t decided yet.

The process started a few weeks back when I called the pharmacy.  I was out of refills.  They called the doctor.  I called the doctor.  The doctor sent the refill.  Then the insurance company told the pharmacy that they needed prior authorization from the doctor.  The pharmacy then contacted the doctor’s office.  They were closed for the week of Christmas and new year’s.  It’s a small office, just the doctor and one staff member, but I was still annoyed.  Next, the administrative staff member tried to send in the authorization, but there was confusion about the insurance, so she called me.  I had forgotten to tell them about my new insurance.  Oops.  Ok, that was totally my fault.  I scanned a copy of my new insurance card and emailed it to her.  She told me she received it and would take care of everything.  More than a week went by and I didn’t hear from the pharmacy, who was supposed to call.  So I called them.  I assumed everything had gone through and they had just forgotten to send the order.  Nope.  It turns out, the paperwork from the doctor’s office didn’t go through.  They contacted the doctor’s office and the paperwork was sent.  I got a call from the pharmacy that the insurance company was processing it and that it can take up to three days.  Then today I got another call that it might not go through.  I asked how much it would cost out of pocket.  I figured I could pay $30 or $40 if I had to.  It’s $104.  Hmm, not in the budget.  I called the insurance company.  They told me to call the company that handles their prescriptions.  Those folks told me it was still being processed.  Apparently, they need the doctor to explain why he is prescribing this particular drug, instead of having me take something else.  They called his office, and were told to call back on Tuesday.

I need the new prescription by the noon dose on Tuesday.  Let’s say the doctor gets back to the insurance company on Tuesday and actually satisfies their questions.  Let’s say the insurance processes things quickly and sends approval to the pharmacy on Wednesday.  The pharmacy is quick, and could probably send it out on Thursday.  That means I could receive it by UPS on Friday.  3 days too late.  And that’s if they move quickly.  That’s if they even approve it at all.  I won’t take a different drug, not with the kinds of side affects I’ve had in the past.  But then, what choice will I have?

So it looks like 1 month wasn’t enough time to refill this prescription.  And I found the flaw in my supposedly-great health insurance.  It could be a rough month.  As the time approaches, I’ll have to warn my friends about my likely upcoming moodiness.  And that will be around the time I expect to hear about the disability insurance appeal, so I’ll be on edge anyway.

There are many, many ways that the system lets us down, that it seems to put the needs of the patients last, that it makes an already bad situation even worse.  This is just the one I’m dealing with today.  By tomorrow, I’m sure I’ll be dealing with another.

4 Responses to The doctor-medication-insurance run-around

  1. anet37 says:

    That’s a shame. You’d think that a month would be enough. My insurance is changing quite a bit in the past 6 months also but so far no crises.
    I hope it works out

  2. rachelmeeks says:

    Ugh I am in the middle of the same thing right now. I recently started antidepressants, obviously not a life-saving drug either, but it sure has made my life easier. I’m still untangling the mess, but today’s my first day without antidepressants in my system. So far it’s all okay…. but I’m worried. I’ve never missed a dose before, and with other medicines my body does NOT like missing a dose. Of course, this is the first medicine I’ve taken for mental reasons, everything else was physical and had physical consequences. So maybe everything will be okay…. fingers crossed.

    But UGH. Insurance companies! But I hate the pharmacy more – they say they’ll call? They never call. I have to call like hourly to make sure anything’s even getting done. So ridiculous!!! This is not my job, this is THEIR ACTUAL JOB, and they don’t do it. Any other occupation did that, and people would get fired. Movies wouldn’t get made, business deals wouldn’t go through, and you know what? That’s peanuts compared to a person’s health.

    But I’m a minority on that front. Most people prefer that movies get made and don’t really care what pharmacies do.

    • chronicrants says:

      Ugh, that sucks! I’m so sorry to hear it! There should be one, and one one reason that anyone stops taking any kind of medication: because you and your doctor decide it’s the right thing for you to do for your health. That’s it. Money and health insurance are NOT good reasons, and yet so many of us stop taking meds for those reasons anyway. It’s just wrong, plain wrong. I hope that you’re transition goes well – GOOD LUCK!!!!!

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