Tag: insurance woes

Pressha!

I have been on a medication for the past 12 years. It’s not an MS specific drug in the sense that it is not one that slows down the progression or anything but it is one of the few drugs on the market that targets a symptom (why can’t I ever spell this word on my first type? EVER!) of the disease. That symptom? walking! Soon after it was approved by the FDA, Gilbert and I talked about it, he wrote me a prescription and the rest is history. It’s a twice daily, extended-release pill so I take 1 at 8am and the other just before I go to bed. Some years ago when I was still on my favourite drug throughout this ordeal, Tysabri, and was still going to the MS Center of Atlanta (MSCA), a nurse practitioner suggested that I go down to once a day to see if I really had to keep taking 2. I did that for about a week, if so long, and that’s when I discovered that not only did the medication help my walking, but it also actually helped with my overall feeling of wellbeing – I went back to 2.

So yes, after a long 11 years or so, my relationship with the MSCA came to an end in 2020. Unbeknownst to me at the time I found them, closed my eyes and chose Gilbert to be my doctor, they had a partnership with another neurological clinic with which he was affiliated – I learned over the years and realized that this was the reason i could only see him on Tuesdays. Anyway, in 2020 I received a notice that the 2 institutions were parting ways and I could either stay with the MSCA or go with Gilbert. I actually decided to break up with both of them to support a black, female doctor whom I’d met at the MSCA and had started her own MS Wellness practice. Oh yes, this was perfect, I can support and get the care I need, even though it was a lil ways away from me. Well. I’m not one to complain but the first time I saw her, I actually told her about my experience with her staff – it was that bad…I won’t bore you with details but understand that I’m back with Gilbert at his other clinic! I have a really hard time dealing with incompetence and bullshit in my old age (except when it comes to my name…I just need to deal with that; nothing is going to change. I was actually referred to as “Stacey-Samuel the other day. LOL, that was a first but I digress)

I’ve often talked about my insurance and my realization that it appears to be quite good based on other stories I’ve heard. I really have no complaints especially after I completely understood the terms, how things work etc. That is until now…sigh! The prescription for that same medication above, has to be renewed annually and so at some point every year after I place a refill order (I have to refill monthly), I get a notice from the pharmacy that “we cannot fill your prescription without prior authorization from your insurance company. We’ve reached out; no action needed on your part” and a few days later, “your prescription is being filled and will be shipped on…”Well last month I got the “we cannot fill” notice…okay, no problem but then on March 10th, I got a notice that my insurance “denied the authorization for your prescription.” Wha?!? Action was now required on my part.

Forgive me if the next few sentences lil hard to follow…Sigh…between then and Friday gone, I’ve spoken to the insurance company reps, who’ve said that the issue has nothing to them – it’s the pharmacy, the pharmacy reps who have said that my request “needs additional review” what review? who can I talk to? no one, “they’ll” only speak to someone from your doctor’s office…I’m the kissmehass patient and they won’t talk to me! (this is my gripe to you, I didn’t actually say that to anyone) I told one man at the insurance company, “there must be someone that I can speak to (proper grammar be damned), u understand that the request was denied by my insurance; Aetna, you all.” He paused for a moment, I stupidly thought that I was making sense and some headway, and then said quite calmly and nonplussed, “I’ll transfer you to Caremark now” (the pharmacy). I hung up. On one of the days, I actually told the medical assistant at my doctor’s office “please don’t get tired of me but…”. She’s the one from whom I got the most information when she told me that they wanted additional doctor’s notes and, of course, she said that they were submitted.

At the point that it became critical, she told me that Gilbert wanted me to go down to 1 pill a day to stretch them out. I started doing that last Tuesday and it really sucks. My days have been going by in waves – I’ve been taking it in the morning so that I’m okay and can function alright during the waking hours but toward the end of the day and by the time I get in bed, I really don’t feel like myself and I just can’t put into words how I feel until maybe an hour after I take the next one in the morning. I’m also lethargic pretty much all day…Thursday, I found myself falling asleep in the middle of the workday at my desk – GASP! and that is completely unheard of. I was never someone who is against taking drugs but this one really seems to make a difference; I don’t think it’s mind over matter. I’m down to 6 tablets. Luckily because of a Facebook group of which I’m a member, I have a plan for if I run out that I’m going to set in motion today, but I don’t know if it will work and I’m not looking forward to running out completely. EVERYFRIGGIN thing is about money. Is Aetna tired of paying for this drug after all these years? I know it eh cheap. Are they thinking that it seems that I’ve been on it for all these years and I’m not walking on my own, so their investment is not paying off?? Is it simply that someone somewhere along the line, has not done their damn job??? steups

Anyway…stay tuned…