Staying healthy is enough to make you sick.

Anne suffers from clinical depression and has been on several different anti-depressants before finding one that worked well in the form of Effexor. She’s been taking it for the past 6 months or so and it really does seem to help, but this past Saturday when she tried to get the prescription refilled at the pharmacy she was told that a policy change now required her to have a pre-authorization before our insurance would pay for it. We’ve been getting this prescription filled at that pharmacy for the entire time she’s been on it and this is the first time our insurance had given has a hard time about it. Effexor is one of those drugs you can’t afford to just quit cold turkey so we went back up to the pharmacy and I bought a week’s worth of pills for her to the tune of $64 for 14 pills. Yeah, it’s not a cheap medication as the full prescription would’ve set us back $256 or so.

Needless to say, I was really pissed off.  And I was especially pissed because my insurance company—Blue Care Network—just raised my rates again the previous week. The pharmacy said they’d put in a call to the BCN who would call our Doctor and ask her to submit a form and then they’d call the pharmacy back and clear the prescription and we’d get reimbursed for the week we paid for minus the copay. On Wednesday we heard from the Doctor’s office, but we still hadn’t heard anything from BCN or the pharmacy on Thursday so I called BCN and learned that they use a third-party “pharmacy benefit manager” company called MedImpact. According to BCN they approved the pre-authroization and forwarded it onto MedImpact and that we should hear from the pharmacy on Friday, but if we didn’t we should call MedImpact. We didn’t, of course, and a call to the pharmacy indicated that nothing had come through yet. So I got on the horn and called MedImpact and was told that their system was indicating that BCN still had the paperwork which they had submitted to them on the Wednesday. Next call was to BCN where I was again told that they had given it their approval and had definitely sent it back to MedImpact, but perhaps MedImpact hadn’t loaded it into their system yet. BCN assured me, though, that it would definitely show up in MedImpact’s system by Saturday without fail.

So today is Saturday and guess what. The pharmacy still hasn’t heard from MedImpact and BCN’s offices are closed on Saturday. MedImpact does have Saturday hours, though, and I just got off the phone with them after trying my best to keep my anger under control. Again I was told that the system at MedImpact was still showing no new updates from BCN. At the moment the authorization is stuck in limbo someplace between Blue Care Network and MedImpact and Anne is once again out of pills. I asked to speak with a supervisor or manager or someone who might be able to expedite this issue and find out who the hell has dropped the ball as my wife’s health is at stake here. After a few minutes on hold the young lady came back and said that they could do a five day override for now and that I’d need to call BCN come Monday.

You bet your sweet bippy I’ll be calling them on Monday. Someone’s likely to be walking funny after I get done with them too.

As it turns out, the policy change that brought all this fun running around into play isn’t really the fault of Blue Care Network. Rather the FDA put the new policy into place after some recent studies which implicate several anti-depressant drugs in actually causing an increase in suicidal thoughts in kids and teenagers taking them. The FDA is also going to run a study to see if the same might be true for adults. As a result all prescriptions are under greater scrutiny and the fact that Anne is taking a dose that’s twice the maximum amount they make, in part because of her weight, was exactly the sort of thing that fell under this new rule from the FDA. So it’s not really BCN’s fault that we have to jump through hoops, but that doesn’t excuse them for not handling the claim processing in an efficient and timely manner. We were told it shouldn’t take more than three days and we’re now headed into the second week of trying to get this resolved and I’m not at all happy about it. To top it all off I now want to have her Doctor look into if Anne’s at risk for the health risks Effexor appears to carry with it and, if so, what other treatments might be considered as a replacement for it.

It’s getting to the point that I don’t think I can take the stress involved in trying to keep my family healthy.

21 thoughts on “Staying healthy is enough to make you sick.

  1. 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.

  2. 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.

  3. 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

  4. 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?

  5. 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.

    rob@egoz.org

  6. 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.

  7. 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

  8. 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.

  9. 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)

  10. 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.

  11. 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.

  12. 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!

    rob@egoz.org believe heathcare is a human right

  13. 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

  14. 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.

  15. .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.

  16. [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.  mad

  17. 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!

  18. 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.

  19. “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.

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