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        New Message Board Archives >> 2007 General Board Posts >> WooHoo I win!!!!!!!!!!
        
(Message started by: Tiannia on Oct 18^th, 2007, 2:03pm)

Title: WooHoo I win!!!!!!!!!!
Post by Tiannia on Oct 18^th, 2007, 2:03pm

Can we have an over flowing bowl of sarcasim?

Well even though the doc put me on Lipitor and I eat like a diabetic (cause that is what my husband is), my triglicerides are still rising. Cause the ins would not pay for just a trigliceride med like i was on in Vegas until I tried Lipitor for 6+ months. I just got a call that my cholesteral is doing well but my triglicerides are 453. That is 3x the 150 that they want as a max. Gotta love those genes. Why cant I triple up when it is money involved?

Ah well the doc called and they are going to get me on Tri-Core (?) to take as well as the Liptor and see if that can get it better under contol.

Sorry got the vent, but I wish ins companies would approve what will help not just a well we have to go by the checklist and try thepeople on this that and the other before they give them what the person really needs. If I had had a heart attack could I have sussessfully sued the Ins Co for not letting me take the trigliceride med when I got here and keeping me off og it for 10 months?

PF wishes everyone.
Tia

Title: Re: WooHoo I win!!!!!!!!!!
Post by Gator on Oct 18^th, 2007, 2:16pm

on 10/18/07 at 14:03:37, Tiannia wrote:

If I had had a heart attack could I have sussessfully sued the Ins Co for not letting me take the trigliceride med when I got here and keeping me off og it for 10 months?

Interesting question. I would venture to say the answer is no, because they are not refusing to allow you to take it. They are just refusing to pay for it. I had the same problem with Zomig. I had been using Zomig NS and then switched insurance companies. The new insurance company made me switch to Imitrex injections, even though they are almost three times more expensive. Didn't make financial sense to me, but they were paying for it. In the end, it turned out that the trex worked faster for me, which is what it is all about.

Sorry you are having such trouble getting what you really need. Hope you can get things straightened out soon.

Mike

Title: Re: WooHoo I win!!!!!!!!!!
Post by Tiannia on Oct 18^th, 2007, 2:40pm

/huggs Mike. Just frustrating. And it worries that crap out of my husband. At is just another thing that he can not fix, and make better and that really gets to him with my health.

No I suppose I could get the Tri-core but the pharmacy just called and said they wont fill it until they get the pre-auth from the ins company. I did not even ask how much it was. :-/

Title: Re: WooHoo I win!!!!!!!!!!
Post by Brewcrew on Oct 18^th, 2007, 2:51pm

I think what Mike's saying is that you could walk into the pharmacy with your script in hand, give it to the pharmacist and pay cash for it. There is nothing preventing that. The insurance company would maintain that you always have that option.

Title: Re: WooHoo I win!!!!!!!!!!
Post by Rosybabe on Oct 18^th, 2007, 2:56pm

Do you eat pastas, cookies, cheese, bread???

I came out high for the Tris in my last test (back in may) and the Doctor prescribed Oraxadin, once a day for a month, it took the tris way down, so He asked me to stop taking it and now I have to watch what I eat... :(, I hate it because those things are my favorite food :)

BTW my meds cost me in mexico a box of 15 tablets $35 USD...it is outrageus how much they want for meds here...

Title: Re: WooHoo I win!!!!!!!!!!
Post by Tiannia on Oct 18^th, 2007, 3:24pm

I cant eat a lot of pasta but I get the wheat kind when I make it. With Shaun we ahve to careful with carbs because it kicks his blood sugar whay high. Mine wont go down without meds, even with the triglide they had me on, the lowest it has been was 280. with diet as well. I just love how your gene work against you sometimes. >:(

Brew, I know I can pay for it myself, but intell I get this job for certain and am not a temp, I really dont have the extra money to do it. in March, they innsurance company sent me a letter that said I had to be on liptor for 6 months to prove it would not maintain it. It has been that + now, so I should be able to get them to authorize it.

Title: Re: WooHoo I win!!!!!!!!!!
Post by BarbaraD on Oct 18^th, 2007, 3:44pm

I had this with my insurance and they asked ME if I couldn't take someting else. I LOST it and said I didn't know a damn thing about meds and THIS was what my DOC ordered -- where the hell did YOU get your damn medical degree and give me your DAMN supervisor!

Then they told me it would take about a week to get the damn thing approved -- I told them fine - that would give my attorney time to get in touch with them by then! I got the damn thing approved!

But it's a damn shame you have to go thru this everytime you get a friggin RX from your doc. HE/SHE should KNOW what you need - not the damn insurance company.

That's what we need to be lobbying congress about - OUCH needs a lobby and we need to support it royally. We're all getting screwed and we shouldn't have to be treated this way. We really need the doc's in on this one. They can't even practice medicine any more without consulting somebody at the insurance company who probably doesn't know a damn thing about medicine and has about a week of training.

Off soapbox!!!!

Hugs BD

Title: Re: WooHoo I win!!!!!!!!!!
Post by Brewcrew on Oct 18^th, 2007, 3:52pm

on 10/18/07 at 15:24:59, Tiannia wrote:

I know what you mean about being behind the genetic 8-ball. Untreated, my cholesterol is over 400. My doc explained to me that any individual can only control their serum cholesterol level by 15-20% of it's natural number through diet and exercise. That means I could knock 80 points off mine by eating lettuce and running a marathon every day. It would still be 320.

I've been taking Zocor for over 10 years, and the last time I had it checked (last spring) it was 176. There's no other way for me. If I had lived in generations past, I'd probably be dead by now.

Better living through chemistry. ;)

Title: Re: WooHoo I win!!!!!!!!!!
Post by Tiannia on Oct 18^th, 2007, 3:59pm

[smiley=hug.gif] Barb.

Do you at least feel a little better?

I'll give them until Tuesday to get it approved. Then I'll sic my husband on them, it is amazing what that man can convince people to do. And it helps that he was an army medic cause he has more medical training then the ins people do and he talks circles around them and they usually end up just agreeing withthem so that they dont look like idiots. ;;D

Title: Re: WooHoo I win!!!!!!!!!!
Post by Callico on Oct 18^th, 2007, 5:10pm

My Dr told me to eat more fish when I saw him for a checkup last week. He said it would help with the triglicerides as well as bring up the good cholesteral. Just be sure it isn't fried. BTW, fish would be good for Shaun's diabetes as well.

Jerry

Title: Re: WooHoo I win!!!!!!!!!!
Post by Charlie on Oct 18^th, 2007, 9:49pm

Only in America is health care something controversial.

Insurance companies and our legislators that collect money from them are evil. >:(

Charlie

Title: Re: WooHoo I win!!!!!!!!!!
Post by Tiannia on Oct 19^th, 2007, 11:36am

Yep Brew. It is funny to hear someone say well control it by Diet and excersise... It mine was 200 then that would be the way to go.

Jerry, We use to each a lot more fish when we where in Vegas. It is more expensive up here , but in spring and summer we can catch our own and that is awesome. Shuan was hoping to get a salmon this fall but the only one he caught did not have its fin clipped (which ment it was a native) and he had to trow it back. It was a nice one too about 25 inches. He was not a happy camper.

Charlie, There are definatly benefits to not dealing with the health care industry in the US> It is so screwed up that we pay hyndreds a month and get told to shove it when something actually needs to be treated.