Tag Archives: insurance

16 weeks 5 days

I’m so frustrated with our health insurance. Well, for the most part our dealings with his company from the patient perspective have been pretty good.

This whole Zofran thing has just been a huge mess of bureaucracy though and I don’t think that this is the way health insurance should be.

So on Monday I called my case manager. She basically told me that she couldn’t do anything about the prescription problem or get me any information about my new insurance, but that she would have someone from another department call me.

The lady from the other department called me and told me that I should call the the insurance companies myself because the management company doesn’t handle approvals for drugs. So I called our (now) old insurance company and they basically just told me what the pharmacy told me which is that they only cover 9 doses a month. Which I still don’t understand because when I was first prescribed this stuff a couple months ago they didn’t put any restrictions on my dosage. So I still don’t know what has changed since then. I didn’t get any answers on this from any of the people I talked to.

Well then I got our new insurance cards in the mail and decided to call that company and find out what they cover. They too only cover 9 doses a month. This representative then gave me the number to the pharmaceutical approval department and said that I should call and talk to them about it. That department repeated the 9 doses a month thing and said that if I needed more that I should have my doctor file a “prior authorization” form and they would possibly approve coverage of more doses.

So then I called my doctor’s office and had to deal with the impenetrable bank of receptionists. They took my message and said that someone would get back with me. I didn’t want to be a pest. I had enough Zofran for Tuesday and went medicine free on Wednesday. I hate dealing with those receptionists so I wasn’t going to bother them until it was necessary.

This morning started off on an inauspicious note and I knew I couldn’t wait longer for my answer to whether they had taken care of the prescription problem because I had exactly one dose of medicine left.

I called the doctor’s office again and was actually transferred to the nurse that assists my doctor. And she gave me her direct line! Finally! She said that I needed to go get a refill under the new insurance and when the insurance only approved the 9 doses their office would receive some paperwork and the doctor could make sure they approve more.

So I just went to the pharmacy and got a refill started. In a couple hours I’ll have 9 more doses. When I pick it up I’m calling the nurse back to let her know that I got the refill like she said to do just to make sure that their office really was notified and that this paperwork thing could go through already.

The thing is I’m fairly stubborn and somewhat persistant. I’m not sure your average person would wait on hold over and over, try calling around to various departments, be OK with being told that I was talking to the wrong person and that I needed to call this other number, etc. How many people actually go through all these steps to make sure they get the care they are supposed to get?

And I just don’t get why, when the insurance company has access to my whole history of this condition, they would think that it is somehow prudent for them to limit the dosage of the medicine that is keeping me out of the ER and off of home IV care. It is much more cost efficient for them approve the medicine which allows me to function like a normal human being (eat food, intake fluids, etc.) than to have me not get the medicine I need and wind up with a $3,000 ER bill so I could get an IV and the same medication that I was supposed to take anyway.

Sorry that this post really doesn’t have much to do with my pregnancy, but I am just frustrated.

One other thing about medicine and this pregnancy that I’ve been thinking about a lot. I guess I’ll just say that this is another thing that was completely unexpected for me.

If you know me, you know that I like to eat as much natural/organic food as possible. I try to avoid fast food and processed junk.

I always thought when I was pregnant that I was going to be as natural as possible and not put anything into my body that was weird. I was going to try and avoid uneccesary medications, have a natural birth, etc.

It’s just a lifestyle that is important to me and has been important to me for some time. I don’t even go to the doctor unless I am really, really sick because I know they’re just going to hand over antibiotics and I don’t think that those are the answer for everything.

If I had a choice I wouldn’t be so dependent on this medication. I wouldn’t even take it.

I guess through this whole process though I am learning that I can’t just be in control and everything can’t always go completely my way. I’m not even guaranteed a natural birth. The baby could decide not to turn or something else and I could wind up having to have a c-section. I guess pregnancy, and life in general, isn’t predictable and it isn’t in our control.

I want to be completely better. I really do. I don’t ever want to throw up again. But that’s just not where I’m at right now. Right now I have to take the medicine on some days to feel normal. And I’m learning to be OK with that.

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