Deleted
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Jun 1, 2024 19:05:46 GMT
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Post by Deleted on Jan 5, 2020 7:51:05 GMT
Isn't it lovely when your private insurance company decides to deny a needed infusion for your teen who has been on said med since September because all of a sudden they deem it is no longer necessary and she no longer qualifies because TO THEM she does not meet the 4 requirements of said med?!?!?!?!?!?!?!?!
Fu-k you. Just f u c k you. F your comfy little office job. F your "knowledge" of her rare condition. F your denial.
Guess what dumb ass, she still meets every single God damn requirement for her infusion med. Every. Single. One.
And without it she could end up in the PICU because she gets very very very very sick.
According to her team "oh we just submit a new yearly rx request and she just continues her infusions..." š¶
Hmm...yeah. NOT that simple.
So now yet AGAIN I get to play phone tag between medical team, insurance, and medical group.
Last time it took over 20 hours of phone time and 3 months of paper work...
Any guesses how long it will take this time?
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Post by nlwilkins on Jan 5, 2020 7:57:28 GMT
So sorry you are dealing with this. I hate when desk-sitters the next state over think they know more than the doctor in front of the patient. It is not as if the doctor is getting a kickback or anything for prescribing the treatment.
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smcast
Drama Llama
Posts: 5,333 
Location: MN
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Post by smcast on Jan 5, 2020 8:28:20 GMT
Grrrr! Makes it very hard to take care of patients. Insurance companies are not fun to deal with.
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michellegb
Pearl Clutcher
Posts: 3,915
Location: New England and loving it!
Jun 26, 2014 0:04:59 GMT
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Post by michellegb on Jan 5, 2020 9:50:14 GMT
I am so sorry you have to deal with this nonsense. It's insane.
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Post by AussieMeg on Jan 5, 2020 10:02:41 GMT
Health care in your country is fucked. Insurance companies are evil.
I'm so sorry you - and your daughter of course - have to go through that. I hope you're able to get it sorted and she can get the medication she needs.
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Post by LavenderLayoutLady on Jan 5, 2020 11:07:55 GMT
Validated!
Totally freaking validated!
I feel this post so much. I have dealt with similar insurance situations where my kid has been on a med for a year+, then suddenly insurance decides to decline covering it. Then I'm calling the insurance, the doctor, back to insurance, having the doctor's team rewrite the necessity paperwork to match the criteria for insurance to cover it.
I hate the greed that is the insurance companies.
You have my utmost sympathy.
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Post by jeremysgirl on Jan 5, 2020 11:43:16 GMT
Woah! I am sending you a hug. I can't imagine just how overwhelming that must be. I have to appeal for my bipolar meds every six months. It is a bit of a pain in the ass but I've never once been denied. And when it's me, it's me. When it's my child? It's a whole other level of worry. I'm so sorry.
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DEX
Pearl Clutcher
Posts: 3,355
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Post by DEX on Jan 5, 2020 11:54:51 GMT
 My late husband was denied (or charged an exorbitant amount, I can't remember) his insulin because it was considered a "luxury drug". He was using an insulin that had been around since I started my career in 1979. Seriously, but I am sure that Viagra is $4.00 a month... 
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muggins
Pearl Clutcher
Posts: 2,861
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Post by muggins on Jan 5, 2020 12:17:26 GMT
I am so sorry. The American healthcare system is indeed fucked and Iām sorry you have to deal with this kind of bullshit.
My friendās young adult daughter and ex student of mine has been in and out of hospital in extreme pain for the past 22 months. She still doesnāt have a clear diagnosis and is being refused pain meds. She no longer qualifies for disability financial aid. They are being evicted from their apartment this month:(
Another friendās brother died from a heart attack in CVS last year. A week later the insurance company sent his widow a bill for $8,500. They charged $3,500 for the (obviously failed) CPR by the paramedic at the scene. Un-fucking-believable.
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Post by librarylady on Jan 5, 2020 13:38:50 GMT
My late husband was denied (or charged an exorbitant amount, I can't remember) his insulin because it was considered a "luxury drug". He was using an insulin that had been around since I started my career in 1979. Seriously, but I am sure that Viagra is $4.00 a month... We have had to get a letter from his doctor that he really needed the insulin. sheesh..........do they think he is getting a high on it?
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Post by librarylady on Jan 5, 2020 13:39:30 GMT
OP...I validate you. Some clerk needs a chain jerked very hard......
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Deleted
Posts: 0
Jun 1, 2024 19:05:47 GMT
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Post by Deleted on Jan 5, 2020 14:54:23 GMT
So sorry, @sunnycalimom. I wish people would wake up and start voting for public healthcare. I hope someday they will. It makes me ill how many stories like yours people deal with every day on top of the underlying conditions.
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Deleted
Posts: 0
Jun 1, 2024 19:05:46 GMT
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Post by Deleted on Jan 5, 2020 15:34:03 GMT
Speaking of Viagra, did you know it is also called Sildenafil AND is a common Pulmonary Hypertension med? That is what it was made for but during testing they realized it caused erections?
So a med that was created for PH was denied for my son's extreme case of PH because it would cost about $3000 a month (we had to pay $75 as our copay)....
It took childrens 2 weeks to get it covered.
So they'd rather pay PICU daily fees than $3000 for his med.
š
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Deleted
Posts: 0
Jun 1, 2024 19:05:46 GMT
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Post by Deleted on Jan 5, 2020 15:36:06 GMT
Oh and after 9 months on the med his PH reversed itself. It was so bad he qualified for a heart and lung transplant that we said no to.
Wonder how long that would have taken to be covered...
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Post by MissBianca on Jan 5, 2020 15:47:46 GMT
Itās crazy here. My friend has monthly electro shock therapy for her depression, depression so bad sheās typically hospitalized for at least a month every year. She got a note from her insurance that she can no longer have the therapy because sheās cured. They actually said it was no longer medically necessary because the treatment was deemed successful.
They were successful because she had the treatments continuously.
They also tried to cancel her appointments with her therapist and she was told by insurance she didnāt need group therapy anymore either.. And once you are out of the loop itās harder than hell to get back in. Thankfully she knows the director of the group and was able to finagle her way back in. But still no shock therapy so we are waiting for the bottom to fall out again. Last year she was inpatient for 3 months.
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Post by lucyg on Jan 5, 2020 15:49:57 GMT
It is awful. And reprehensible. Iām so sorry you have to deal with this. There needs to be a better way.
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Post by mom2ja2 on Jan 5, 2020 15:50:41 GMT
Ugh, so sorry! Our insurance system truly does suck.
One of the most common arguments I seem to hear is "Oh if we got universal health care we'd never get appointments - the wait is terrible."
I feel like our wait is already terrible. If you need a specialist you're often waiting months...and then you're paying hundreds (thousands?) of dollars for that appointment. My dd had an endoscopy last year to figure out why she was having severe stomach aches, it took 4 months to get scheduled, and was 7 grand out of pocket for us. 7 grand. And I think of countries with health care and maybe I'd still have the 4 month wait, but I'd take that over losing 7 grand of savings.
I'm currently trying to schedule a dermatologist appointment for my oldest who has a couple of warts on her fingers. We've been to our GP, and this is the next step. So far the earliest appointment I've been able to land her is the last week of April.
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Post by quietgirl on Jan 5, 2020 16:22:48 GMT
I'm sorry. I deal with something similar (different condition, different meds, and for me, not my kids), but I validate you, and I get it. Hoping some light bulbs turn on soon with these people.
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Post by stormycat on Jan 5, 2020 16:29:29 GMT
Ugh, so sorry! Our insurance system truly does suck. One of the most common arguments I seem to hear is "Oh if we got universal health care we'd never get appointments - the wait is terrible." I feel like our wait is already terrible. If you need a specialist you're often waiting months...and then you're paying hundreds (thousands?) of dollars for that appointment. My dd had an endoscopy last year to figure out why she was having severe stomach aches, it took 4 months to get scheduled, and was 7 grand out of pocket for us. 7 grand. And I think of countries with health care and maybe I'd still have the 4 month wait, but I'd take that over losing 7 grand of savings. I'm currently trying to schedule a dermatologist appointment for my oldest who has a couple of warts on her fingers. We've been to our GP, and this is the next step. So far the earliest appointment I've been able to land her is the last week of April. [b I just tried to schedule a developmental pediatrician appt for my 3 year old and the wait list is 12-18 mo. I have to say if you think finding Mental Heslth care for adults is, you should try finding help for children. |
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Post by refugeepea on Jan 5, 2020 16:29:36 GMT
I'm so sorry. I completely understand. My daughter was diagnosed with Autism. Now that she is 18 she has to be reevaluated all again to qualify for disability. It is overwhelming. I sent in LOADS of paperwork before her birthday. I'm going to look into getting a disability lawyer because I can't handle this on my own anymore.
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julieb
Pearl Clutcher
Posts: 2,845
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Post by julieb on Jan 5, 2020 16:35:17 GMT
I'm so sorry. This is the third story I have heard since New Year's of coverage denial. Why oh why do the insurance companies go against a doctor's recommendation. It really should be a law that insurance companies cannot deny coverage that a doctor deems necessary!
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Post by freecharlie on Jan 5, 2020 16:38:30 GMT
I'm sorry.
Dh was recently denied an insulin pump because the insurance decided it wasn't needed. He has had a pump for 4 or more years, but since this once is acting up and he needs a new one, they don't want to pay for it.
Our doctor was telling us all the stupid insurance hoops he has to jump through. Ds was getting a new nebulizer (his was at least 15 years old) and in order for insurance to pay for it, ds had to physically go into the dr to make sure he still had asthma.
While their dr told us of one patient that they made that guy go into the dr to get new leg braces. The man had had them since childhood and was in his 30s or 40s and the insurance company made him be seen in office so his doctor of 20 years could say they were necessary.
My doctor told me he was billing our insurance for the visit, but that I was not to pay a dime for having to come see him.
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Post by leannec on Jan 5, 2020 16:43:15 GMT
Health care in your country is fucked. Insurance companies are evil. I'm so sorry you - and your daughter of course - have to go through that. I hope you're able to get it sorted and she can get the medication she needs. Yup, here in Canada you would not be dealing with this nightmare  Hugs to you  |
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Post by Merge on Jan 5, 2020 16:48:42 GMT
Wait, you mean the Trump administration hasn't provided you with a list of affordable plans from which you can choose? I'm shocked. It was a major campaign promise.
(So sorry you're dealing with this. My sympathies. We're all there at some point. What my sister goes through to get their insurance to pay for standard treatments for her kids with CF is insane. It's a full time job for her, dealing with insurance.)
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Post by scrapmaven on Jan 5, 2020 17:28:31 GMT
Insurance companies are horrible. I fight for stuff all the time. A customer service person is not equipped to make medical decisions for a rare disease. Even when it is reviewed by their doctor that's not right. A doctor at an insurance company is not a sub-specialist and has no business overriding an expert. Sing it, @sunnycalimom . You shouldn't have to fight like hell for your kids to get much needed treatment. IVIG makes a huge difference. Let the jackasses at the insurance company experience the disease w/o the IVIG treatments for one day and I guarantee you they'd approve it. When will our right to great medical treatment be realized?
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Post by revirdsuba99 on Jan 5, 2020 17:58:33 GMT
Isn't it lovely when your private insurance company decides to deny a needed infusion for your teen who has been on said med since September because all of a sudden they deem it is no longer necessary and she no longer qualifies because TO THEM she does not meet the 4 requirements of said med?!?!?!?!?!?!?!?! Are you using insurance through your employer, whether they pay or you pay part or all? Have you spoken to Human Resources? They should know and still be able to help you with the insurance. They are making the choice which companies to buy from, it is their responsibility to their employees! There may be others who are also having issues. |
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Post by busy on Jan 5, 2020 18:39:24 GMT
OP...I validate you. Some clerk needs a chain jerked very hard...... The situation is terrible but itās far from a clerkās fault. They donāt create the horrid guidelines, they just have to stick to them. |
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Deleted
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Jun 1, 2024 19:05:46 GMT
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Post by Deleted on Jan 5, 2020 18:41:04 GMT
Isn't it lovely when your private insurance company decides to deny a needed infusion for your teen who has been on said med since September because all of a sudden they deem it is no longer necessary and she no longer qualifies because TO THEM she does not meet the 4 requirements of said med?!?!?!?!?!?!?!?! Are you using insurance through your employer, whether they pay or you pay part or all? Have you spoken to Human Resources? They should know and still be able to help you with the insurance. They are making the choice which companies to buy from, it is their responsibility to their employees! There may be others who are also having issues. 100% covered private plan through DH's work. We can either take the POS plan (hmo/ppo) or upgrade and pay OOP difference for Kaiser. We have a top of the line healthnet plan and believe me, the district gets plenty of complaints. BUT it has been a hell of a lot better than when we had PacifiCare. |
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Deleted
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Jun 1, 2024 19:05:46 GMT
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Post by Deleted on Jan 5, 2020 18:43:00 GMT
Wait, you mean the Trump administration hasn't provided you with a list of affordable plans from which you can choose? I'm shocked. It was a major campaign promise. (So sorry you're dealing with this. My sympathies. We're all there at some point. What my sister goes through to get their insurance to pay for standard treatments for her kids with CF is insane. It's a full time job for her, dealing with insurance.) We get 100% covered POS (hmo/ppo) plan through DH's work. It allows us to easily go out of network for DD's medical needs. It is one of the top of the line plans. However our medical group is a piece of shit and the cause of most of our issues. Previously insurance said yed to the costly IVIG med, but our medical group denied access to it. By law no one can deny you access to a covered med. |
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sassyangel
Drama Llama
Posts: 7,456
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Post by sassyangel on Jan 5, 2020 21:33:52 GMT
Iām sure it wonāt make you feel better, but even employees of health insurance companies have to deal with this BS. Im one, and just got done over Christmas fighting to get the Trulicity my husbands doctor prescribed for him, approved. This was after the doctors prescribing it because he checked the formulary, and found it was the preferred one. So I understand your frustration and feelings.
I hate that insurance companies have so much say over something should be between a doctor and patient. Stuff like this makes me embarrassed that I work for one.
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My late husband was denied (or charged an exorbitant amount, I can't remember) his insulin because it was considered a "luxury drug". He was using an insulin that had been around since I started my career in 1979. Seriously, but I am sure that Viagra is $4.00 a month... 
