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dealing with Dr.s, pharmacy and Health Ins./Stressed and frustrated
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bpcookie posted:
Hey peeps, I'm having a Hell of a time trying to get my meds and a procedure done for my VLSC. Three meds have to have a pre approval from my Health Ins. I need my Lunesta, Omeprisol (antacid) and a cream for my back pain. If I don't have my Omeprisol, eventually stomach acid and food will come up into my throat and it can burn my esophagus and I will also start throwing up.

I have been on the phone with my Dr.s, pharmacy and health ins. for 4 and a 1/2 hours, none stop. I need to get my procedure done and the pain specialists kept giving me excuses, BS and blaming my ins. for the delay. My Dr.s have yet to fill out the pre approval form for my meds. The pharmacy is also confused and giving me BS. Everyone is friggin lazy. I can't get anyone to do their damn job, some of them give me excuses, some blame others, some play dumb (I really don't think they have to do much acting) and some of them even lie.

All I want is my meds and to get the procedure done!!!!!!!!!!!!!!!!!!! Im so mad, stressed, frustrated and I feel so helpless to do anything about it.
WebMD Health Ambassador, BpCookie
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ddnos responded:
Hi COokie, I'm sorry you are going through all this insurance crap! I'm curious, are the three meds ones you have taken before or are they new? If you have taken them before, did you have to have them pre approved then? I'm asking for a couple reasons. 1) I have one of my meds that have to be pre approved once a year, and 2) if they are new meds for you or meds that are no longer on the formulary of your insurance, your doctor needs to call to ask for what's call "an exception" Those words. More often than not, the insurance company will go ahead and approve the med based on your doctors request for an exception, and then it will immediately be entered into the system in your records and the pharmacist will then be able to dispense those meds.

So, the one you need to talk with about getting your meds approved are not the insurance or pharmacy, but your doctor who is prescribing the meds. Then they can call (or have a nurse call) the insurance to requestion that exception.

I don't know if you need any of those meds like TODAY or if you have any to hold you over, but if you need them today, as they say, the squeaky wheel gets the grease, and so I would get on the phone with your doctor and cry if you have to. lol

As far as the procedure - are you waiting on the referral for that or for whoever is doing the procedure to schedule you in?

Good luck!

Hugs
Debbie
Forgiveness is letting go of the hope that the past could have been any different --Unknown
 
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sandtiger responded:
((((Cookie))))

So sorry this is happening to you ... I've never had much trouble with my insurance (knock on wood), but I've known a lot of people who have. Just keep bugging them, they'll cave eventually.

Try to take some time for yourself every time you get off the phone with them. You know, de-stress a bit, so it doesn't ruin your whole day ...

((((luvs))))

~San
:: Living is more than just being alive - Anberlin ::
 
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bpcookie replied to ddnos's response:
Hey Deb., yup Ive taken them before but now the ins. wants pre approvals on certain meds. Usually the ones that cost a lot. I finally got one med. approved but its going to cost $280. Ouchie. This med is for acid reflux. The other med that I'm waiting for is Lunesta and I'm trying to start a fire under my Pdocs butt, but they never answer the phone so I have to leave messages. uuggghh.

I finally got the procedure apt. made. That took me a while to do. Called the health ins. and explained what was going on, she then put me on hold while she called the pain specialist and told them that I did NOT need pre approval for the procedure. Then I called the pain specialist and asked to talk with the supervisor. I was tired of dealing with the front office. He wouldn't transfer me, instead he made excuses AGAIN and I caught him in a lie and I shoved it in his face and he got pissy with me and I got pissy back. Finally he made the apt. So I get the procedure done tomorrow.

Its so annoying when all you want is something so simple but yet you have to go through so much stress and deal with ppl who don't want to do their job.

Thanks honey bunny.
WebMD Health Ambassador, BpCookie
 
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bpcookie replied to sandtiger's response:
San honey bunny, After calling my health ins. over and over, I realized that they are actually very helpful. They put me on hold and then call the Dr.s and pharmacy, that way I know that they have done their job. Its the pharmacy and Dr.s who I have to argue with. But telling them that I was on the phone when the health ins. called them, helps a lot.

I have my procedure apt. for tomorrow and I finally had one med. filled and ready to pick up. Its the most important med.

Thanks my dahling. muahs
WebMD Health Ambassador, BpCookie
 
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sandtiger replied to bpcookie's response:
Oh, that sounds great, Cookie!

Still, a little self-soothing anyway couldn't hurt. Maybe with a chocolate sundae with cherries on top and whipped cream! lol ^_~;;

~ San
:: Living is more than just being alive - Anberlin ::
 
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bpcookie replied to sandtiger's response:
Well, Im off to eat some chocolate cake. Dinner is only an hour away too. lol but I don't care. hugs
WebMD Health Ambassador, BpCookie
 
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ibex7 replied to bpcookie's response:
A good tip, Cookie, is to check prices of your meds at various pharmacies in your locale. I saw a news clip on one price that was phenommenal. $21.33 at one drug store, the same med just down the street was $149.99!

Everybody, shop for your meds.
 
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bpcookie replied to ibex7's response:
wwwhhhoooaaaaaa. hhmm, I should call Target, Walmart and Walgreens. I had no idea that some cost more then others. A bunch of rip off...jerk faces. Thanks for letting me know Goat.
WebMD Health Ambassador, BpCookie
 
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skypper replied to bpcookie's response:
Yes and Target and Walmart (not sure about Walgreens) have a list of $4 meds, so even if your regular co-pay is $10 there you will only have to pay 4, its a good deal, but its also a set list, i believe you can check online to see if any of your meds are covered under their programs.
I had one med that cvs always charged me the regular 10 or 15 dollar co-pay and come to find out it only cost like 8-something CASH and they were just trying to get the max money out me the whole time, I was so mad!
~Sky~
When nothing's going right, go left!
 
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bpcookie replied to skypper's response:
OMG!!!! seriously? What a bunch of rip offs. huh. Maybe thats what they have been doing to me all along. Taking advantage of ppl who have health ins. co-pays. Because Im having to pay cash for my meds until I reach my deductible, all of a sudden my meds are a heck of a lot cheaper. I got Hydrocodone for $3.80 and most of my other meds are under $8 now, except for a few meds that are freakin expensive. Even Divalproex and Lamictal was about $8, before I was paying $40 and $60 for those meds. gggrrrr
WebMD Health Ambassador, BpCookie
 
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skypper replied to bpcookie's response:
That is exactly what I'm talking about cooks! Makes me mad, I could have been paying the lower CASH amount the whole time but they just wanted to bill the beejeezus out of me & my insurance
~Sky~
When nothing's going right, go left!


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