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        New Message Board Archives >> 2004 Posts >> What's wrong with this picture?
        
(Message started by: CarrieBethRN on Aug 6^th, 2004, 4:27pm)

Title: What's wrong with this picture?
Post by CarrieBethRN on Aug 6^th, 2004, 4:27pm

Well I think that a lot of you have read my past two threads on my insurance, pharmacy, doctor problems lately. Today I have more to update on this story!

I was pretty calm all morning. ;) I had a new patient appt with a rheumatologist at 8am, and he was a really nice guy, so that went well. Then I went to class and as usual, I didn't pay attention..so that was ok, too! :)

At lunch, I decided to call Aetna up and discuss some of these ongoing problems. I was very calm and pleasant and the lady I talked to was actually really great! She and the pharmacy representative for Aetna had no idea how the Amerge thing got screwed up because they'd never seen anything like that happen before. They told me that somehow someone along the line put down that the preauthorization expired 7/04 instead of 7/05. I really don't know whose mistake that was, but it really doesn't matter. She told me to just get my doctor's office to preauthorize it again and it would be taken care of.

So then I asked her about the O2 coverage. She looked it up and said that, yes they did deny it. So she had me do an appeal right over the phone. She was great. She even said that she can't understand why they would deny it if it is the only thing that helps my clusters acutely. She told me that I should get my doctor's office to appeal the denial too so that we got it covered from all angles.

Again, no problem with her on that one! She directed me to how I could find the forms on their website to get my information signed off so that my parents can have access and help me when needed. She was really quite helpful.

So I went to my afternoon class, and I felt happy because that had gone well. Class got out early, so I went and got my bloodwork done that the rheumatologist needs. Then I decided to go up to the headache center to discuss the insurance stuff.

That right there is where the shit hit the fan.

First I get up there and the one secretary makes a face like she always does when I have to go up there and ask a question. Gee lady, sorry I have a problem that I can't fix on my own... But she was ok overall.

The nurse came out and saw me standing waiting to talk to someone. She had a prescription for more lithium (they changed my dose), and I'd completely forgotten I was supposed to pick that up. Then I told her what the insurance co said about the O2.

She then proceeded to yell at me and speak to me like I was a deaf 2 year old child. "YOU HAVE A BASIC LEVEL INSURANCE. THEY DO NOT COVER DME. NO MATTER WHAT WE DO, IT WILL NOT BE COVERED." So I said, "how come they told me that all I have to do is get it prior authorized?" "THAT IS NOT YOUR PLAN. THAT IS OTHER AETNA PLANS." "Ummm she looked it up in the HMO book and read it right to me..." "NO. THERE IS NOTHING WE CAN DO. THEY WILL NOT COVER IT."

Well shit. I just said fine I'll get welder's O2 and looked at the floor. She started to get up in arms over that one regarding not having a regulator and I snapped at her, "Someone is providing a regulator thank you." What I was thinking was, "I have friends who will actually HELP me to feel better...unlike you."

She said she would take care of the Amerge thing and gave me 2 pills to tide me over. She said that was all they had. Well ok...I did get 9 out of the insurance company yesterday...

I told her that Welder's O2 would be fine and good, but it doesn't help the now over $800 bill from the medical supply company. She was like, "What's that all about?" I said that we didn't know they billed that way because blue cross had always taken care of it, so now we have a big bill that nobody will be responsible for but me...since apparently noone is willing to work with me and the insurance on this one. Whatever....grrr...

So then I got on the phone with my mom as I was walking back to my apartment. She got upset about the bill, but my dad said that he was in the process of getting the Welder's O2 secured. My dad is driving from Stone Harbor to pick me up tonight and then bringing me back down there for the weekend. I'm sure we'll try to work some of this out while talking in the car.

*continued......

Title: Re: What's wrong with this picture?
Post by CarrieBethRN on Aug 6^th, 2004, 4:27pm

I wound up getting hysterically upset talking to my mom. I told her that I just can't do this and fight this battle. My health is getting pretty seriously bad in a few different ways, and I am just getting worse having to deal with all of this too. I can't fight them anymore. I can't fight with the pharmacy, insurance company, and headache center anymore at all. The amount of anger and stress that it stirs up when I run into obstacle after obstacle is really becoming quite a problem.

So tonight I'm signing a waver so that my parents have access to my insurance info. My mom said they will help me, and I know my dad will. When he wants something done, it gets done. I told her that I know I am supposed to be responsible for my own things now and that I should be able to handle this, but I just can't. I told her that I need someone to go to bat for me and fight these battles because it is destroying me. She said they will help.

So since all this took place a couple of hours ago, I emailed the office manager at the headache center who is also a good friend. I asked him if we could meet on Monday. I need to discuss what happened today, and I also have some other things I have to talk about with him. He may also be more willing to help me deal with the insurance company regarding the O2. Hopefully he will have time to speak with me. He has been VERY helpful with some of the problems I've run up against over the past few years, so I know he would do anything to help if he could.

Also thanks to Jonny...he is sending a welder's O2 regulator. Big thanks and hugs, Jonny!!!!!!! :)

Also want to thank Jimi, Frank, Big Dan, and KevinM for all the support they've given over the past few days and then some! You guys have been a huge help in helping me get through this crap. Thanks to everyone else who has posted responses and suggestions. I am trying to work through all of this, but it has gotten to the point where I think I need to hand it over to my dad because I have run out of steam.

I think one thing I definately want to work on in some capacity is finding ways that people who need it can have patient advocates. Sometimes we just can't fight it alone. I know I have a lot of times where I am good at handling the crap that happens, but times like this...I need someone else to step in. I just need someone else to say, "It's ok. Let me handle it for awhile." I think a lot of people could use that sometimes!!

There's gotta be better ways to fight these battles without causing so much problems for the people who truly need help. When your pharmacy says the insurance company won't give it, and the insurance company says no, and the doctor's office won't help...what is next? It's definately a problem that needs a solution.

Sorry for the length (again), and if you've read this far then THANKS!!!

Luv you guys,
Carrie

Title: Re: What's wrong with this picture?
Post by Carl_D on Aug 6^th, 2004, 4:43pm

Sorry your getting such a runaround. How bout a hug?
[smiley=hug.gif]

Hang in there,
Carl D

Title: Re: What's wrong with this picture?
Post by alleyoop on Aug 6^th, 2004, 4:50pm

Hi Carrie,

Glad your folks are playing patient advocate for you. Hope everything works out ok! Let me know if I can be of any help.

....................................alley 8)

Title: Re: What's wrong with this picture?
Post by Jeepgun on Aug 6^th, 2004, 4:55pm

[smiley=hug.gif] Hang in there, Carrie... Glad to hear that you're getting some help via your parents and through other channels. Thanks, Jonny.

Keep up the good fight, Dear.

-Frank

Title: Re: What's wrong with this picture?
Post by Jimmy_B on Aug 6^th, 2004, 5:01pm

Sorry you gotta put up with this insurance prob...Usually Doctors are great as long as you can get past the front desk...GRRRR.

Enjoy Stone Harbor, though. I'll be a few miles South in Wildwood this week-end.

Jimmy

Title: Re: What's wrong with this picture?
Post by Kevin_M on Aug 6^th, 2004, 5:54pm

My heart goes out to you reading all this. And my hat goes off to you too for the always trying your best. You are being practical through this and things will get better.
Thanks again jonny.

Hugs kid ;) Have a good weekend!

Kevin M

Title: Re: What's wrong with this picture?
Post by IndianaJohn on Aug 6^th, 2004, 9:26pm

My heart with you too girl. Keep your chin up. Everybody needs help now and then, I know I sure do.

Jonny, God Bless you!

Title: Re: What's wrong with this picture?
Post by Little Deb on Aug 6^th, 2004, 9:28pm

Hugs to you Carrie. Hang in there.

Little Deb :)

Title: Re: What's wrong with this picture?
Post by thebbz on Aug 6^th, 2004, 9:41pm

Keep up the fight, my doc signed a need for medical neccesity form stating its purpose was for an acute medical emergancy. You more than likely already played this one out, or the docs an ass. Good luck

Title: Re: What's wrong with this picture?
Post by Jayne on Aug 6^th, 2004, 10:23pm

It really pisses me off!!! When people are ill they have do all this fightning to get the insurance companies to do what's right.
I am sorry you are having to go through this sweetie.

Title: Re: What's wrong with this picture?
Post by E-Double on Aug 7^th, 2004, 12:27am

Hang in there girlie!!http://smileys.smileycentral.com/cat/23/23_28_121.gif
Gotta tell ya, you're certainly one tough cookie and feel good about the help you are receiving(parents, Jonny, all)
You're certainly loved.

Feel well and stay strong.
E

Title: Re: What's wrong with this picture?
Post by Charlie on Aug 7^th, 2004, 1:57am

We're on your side Carrie and my bet is that things will be looking up. Sounds like you are doing all the right things.

Everywhere I go, I run into the same flunky whose job description is to say "no." Things like good will are a thing of the past. You can get around them but as you say, it takes a lot of work.

Hate these bastards.

You're something Jonny.

Charlie

Title: Re: What's wrong with this picture?
Post by Ronny on Aug 7^th, 2004, 4:07am

Hi,

I'm sorry you have to struggle so hard with the insurance people. You have a really weird system over there. Always fighting to get what you need. That is not right.

>:( Ronny.