Before you call the insurance company, you might want to check this out:

http://www.michigan.gov/wca/0,1607,7-191-26930-40803--,00.html

At least here in MASS having some knowledge of the regulations, and regulators, helps in parting the waters.  These people fear informed citizens and will often do more, more quickly, when they know they’re dealing with one.

Best of luck!

I have been struggling with severe neck, shoulder, and arm pain for years. I finally had surgery last year and guess what? The pain is worse. I have been on Norco, (read: regular strength vicodin X2,) and Soma for going on two years. If I run out, I am in really bad shape.

I, too, have had this run around with the insurance, Doctor, and pharmacy, and it isn’t any fun at all, much less fair. It isn’t my fault that I am in this condition, but while I really like my doc and pharmacy, and the insurance is pretty good, the only person who will go out of their way for me, is me.

My advice to you is to do what you apparently are doing. Be a pest. Call frequently, and don’t wait for them to call because often they do not. You are a file on someone else’s desk, and to them you are not much more than that.

Good luck, Les. I do not know you or your wife, but you both have my best thoughts.

Les - I’m glad you took the time to post this as prescriptions and medical conditions are something near and dear to me.  I won’t get into all the details but I encountered a similar problem with my insurance carrier and took the time to sit down and explain what was happening to my physician.  In the end, she decided to write me to prescriptions for the same medication which expired on off-setting weeks.

What this accomplished was a bypass of the scrutiny of the FDA and allowed me to get to extra dose of medication I was prescribed without hassling with the insurance company.  I’m 6’1, 240 so normal dosage doesn’t usually apply to me either.  This has been going on for almost two years without any problems once we got it set up.  Good luck Anne and thanks again Les.

I used to be on a regimen of psyche meds.  I tapered myself off them when my parents wouldn’t let me make an appointment doc (they know now, finally)....I’ve done better since I got off the things.  One of them was Effexor....makes you feel good for a time....but when you feel bad you feel REAAAAAAALLY bad.  Take that with a grain of salt, as most of these medications are still a work in progress and affect everyone on them differently. 

My $0.02

I hope Anne didn’t/doesn’t have to do without the Effexor at all, but if she does, see if you can get some doc to prescribe some prozac. It seems to take the edge off of the withdrawls from Effexor, which can be HELL on the one withdrawing and those around them (been there, done that, with no prozac and with it.)
And to Slick...just because it didn’t work for you doesn’t mean it won’t work for others. The only reason I am addressing your comment is because I worry that comments like that will discourage an honestly depressed person from trying anything. When things feel so bad in your life that you feel nothing will ever change, sometimes meds are needed even if it doesn’t work forever. And reading a comment like that could send a person who was about to reach out for a little help back into bed. Slick I am glad you are doing well off meds, but some of us need them still, and some out there need to get on them. Please try not to discourage them ok?

So very true on the above last comment.  Every person’s body chemistry is so very different.  I’ve seen psychotropics work wonders in people’s lives (better than Jesus).

(just had to add that last part)

Anyway, it’d be sure interesting to hear how you two make out against the insurance-borg.

I can appreciate your disgust with the medical system. My wife had kidney failure during a bout of pneumonia. It took nearly two years to get on the list for a transplant, but a year and a half ago her employer changed insurance providers (Jan1, 2003). Three weeks later the local hospital called and said they had a kidney for her - our new insurance company (Aetna) would not approve it.Aetna told us she had to have her transplant at Baylor University in Dallas, but she had to lose weight before she could get on their transplant list. She’s still waiting, struggling to work full time to maintain her medical coverage while undergoing four hours of dialysis every other day.

Rachel-G, I was honestly depressed.  I was in bed for day at a time, largely due to the same family problems that made me have to take matters into my own hands.  Problem is, justas .rob just said, almost all psyche meds are a VERY inexact science.  Helluva lot of trial and error involved, that’s the reason for any intense medication changes, they advise an evaluation period in a hospital.  If anyone feels they need them, by all means try them....but don’t expect them to be the be all and end all of fixer uppers.  I’m of the opinion that it’s better to try and gradually eliminate whatever causes make you feel the way you do, and need the medications you do....that’s a large part of what’s wrong with the medical practice...by and large, they don’t look to the cause of the problem, rather they just find the symptoms, do a surgery, tell you to pop some pills; and that’s it.  This is why so many things recur when they don’t neccessarily need to.  A reason for this is that medicine is now big business, and it’s more advantageous for them to do quick solutions with recurring problems as they get more money that way.  This is not the individual doctors I’m talking about, but the large pharmeceutical companies, insurance companies, etc. 

-Slick

I just find it tragically ironic that an anti-depressant (Wellbutrin XL) can actually cause suicidal tendencies…

Of course, I have plenty of my own tales about being overmedicated (I used to have something like track marks on my arms from all the blood I had to give to make sure a new medicine wouldn’t kill me), but those are stories for another (and more) time.

Les,
Looks to me like you could use dome Effexor - OOPS

Seriously, as Slick said, long-time medications can be hell. There are some tried and true exercises that have helped relieve many people of depression and its symptoms. Yoga, meditation, etc. You may want to consider some of the “alternative” methods to help you out of dependency on something that may not be there when you need it. Notice that most of the “alternatives” that really work for some do not depend on some outside agency or being. It’s a matter of tapping into that infinite capacity within yourself. (PS dome was a typo for some)

Slick, yes it is very true that doctors now a days look for the quick fix, and that they listen to drug reps all to closely. That is the exact reason why a person who needs medication to help with a chemical imbalance in their brain should not see the family doctor, but should see a Psychiatrist who will do a proper evaluation, which for the record does not always need to be done in a hospital.
And Yes, some depressions are situational, but others, are not, and to lump them all into one category is wrong. A person could live in a totally stress free happy environment, and still suffer from depression. And even if it is situational, sometimes meds are needed to help the person start to make a difference in their own lives.
Yes leguru, the natural methods you mention can work for some people, but for others that have a actual chemical imbalance, most of the time they would need to accompany said methods with some sort of medication, whether it be herbal or pharmacy made.
Depression, can be treated many different ways, and no one of them is right for all the people who suffer from depression.

Anne, Les—I hope that gets worked out NOW.

That’s just. . . fucked up. When people take the responsibility of healthcare, they ought to damn well know better.

Too many hands. Way too many hands involved in that one.

I think this is a perfect time to, once again, renew my call to nationalise all doctors as federal employees, seize their homes, and their wive’s new Hummers.

I’d also like to ammend this to include insurers, hospital owners, and various investors of such.

Nationalized Health Care:  It’s coming to hospital near you, soon!

believe heathcare is a human right

Miss G, it’s a tried an true fact that chemical imbalances can be fixed through diet change, excersise, etc.  And I DID go to a psychiatrist, but what do you think a psyche doctor is eh?  I wanted to study to be one for a long time, and probably more than half of their schooling is the same stuff all the other doctors get, with a bumper course on psychotherapy. 

-Slick

Rachel-G, Slick—Some of us defend our meds, some of us refuse to take them and then go an alternative route. Neither way works for us all. Either way works for some. People should be encouraged to consider both.

There really is no debate there.

.rob,
Please, no more bureaucrats in charge of health issues. That’s what got Les and Anne into this mess, bureaurats dropping the ball in handling a simple change of policy (not a typo).
J,
As you said.
BTW, the only blind study of psychotherapy, done at Harvard, showed the same rate of cure in the comparison group as in the group that received psychotherapy - not too encouraging.

[please no more bureaucrats in charge of health issues...]

There will always be a health bureaucracy as long as there is health insurance, nationalized or otherwise.  Someone makes the decision what to pay for and not to pay for.  There is no option not to have a bureaucracy.

What I’d like to see is the patient and doctor moved to the top of the decision-making process.  And our current situation is not one bureaucracy, but hundreds or thousands, with little choice as to which one might be at the mercy of.  (Just getting a job is dicey enough - most of us don’t have a choice of employers, and it is our employers who dictate most of our health insurance.)

At least with a single payer, there’s national accountability and a chance for streamlining. 

Les, I hope someone at your health bureaucracy wakes up right away and realizes this is an urgent situation. 

Les and Anne,
I am so sorry to hear about your med situation--I really hope this gets resolved soon!
My grandfather was one of the seniors screwed by the medicare changes.  He takes coumadin which is a really expensive blood thinner.  It costs him about $100 a month for the prescription but I happen to know that it costs the pharmacy about $20.  The problem with insurance is that it doesn’t serve its own purpose.  It’s almost enough to make me stop paying and just hoard my money in a can under the floorboard. 
Fuck the fucking healthcare fuckers!

We went by the pharmacy on Saturday as we were headed out to Anne’s parents to celebrate her Dad’s birthday. It took a few minutes on the phone for folks at MedImpact to figure out that they had promised us a five day override and Anne got her pills and we were on our way.

I’ll be calling BCN today to find out who the hell dropped the ball and why they can’t this worked out in a timely manner. Thanks to everyone for your suggestions on how to get around this issue. We may end up looking into them if this continues to be a problem.

“My grandfather was one of the seniors screwed by the medicare changes.” I feel badly for seniors who have to choose between rent, food or meds.  However, I am 45 years old, have a good-paying job and health insurance that will not pay the $385 per week in migraine medication it takes to keep out of the emergency room.  I’d imagine there is a whole forgotten group of people out there in my situation - we’re not seniors and we’re not on welfare.  Does anybody give a rat’s ass about us?  Not really.

NOBODY should have to do without their medication, but I wish somebody would recognize that there are a lot of us who are working our asses off, doing what we’re supposed to be doing, and still having to chose between food and medication.