Thursday, January 15, 2009

Otherwise Engaged

Sorry I couldn't visit with you yesterday but I was otherwise engaged.

Last spring I contracted shingles. Believe me, I would not wish this on my worst enemy. I have a very high tolerance for pain but this was simply beyond the pale. It's impossible to adequately convey the insane amount of pain involved. Suffice to say that a person could easily become addicted to pain medications faced with such an outbreak.

Unfortunately, due to my age and other medical problems I developed a condition in which the pain continues, in a greatly reduced intensity, for up to one year. My physician prescribed a drug which was a godsend to me, allowing me to create a somewhat normal lifestyle.

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For some reason I mistakenly believed that I had refills, when in reality I was on my last few pills. No matter, the pharmacy faxed the doctors office requesting a refill. Days later I discovered that the insurance company was requiring the doctor to provide proof that it was medically neccessary. You know, I really don't think physicians are in the habit of prescribing meds that aren't necessary and the cost of the medication makes it unlikely that a patient will fork over the money unless absolutely necessary.

I could be wrong.

I'm still waiting on an answer and unfortunately my actiivity level has suffered. Most of yesterday was spent in bed with little energy to do much but read.

This is just a very small problem in the "world-of-insurance" and there are many people who are faced with huge battles involving life threatening situations. My sister has been put in the unenviable position of being a dragon slayer when it comes to dealing with insurance companies on behalf of her daughter (a transplant patient).

An acquaintance of mine quit his medical practice in disgust saying, "I struggled through many years of medical school and training to treat patients NOT to spent my entire day battling with insurance companies".

I'll be on the phone today, directly to the insurance company, rattling cages and slaying some dragons of my own.

I know there are plenty of horror stories out there. What's your experience?

20 comments:

chocolatechic said...

I have been fortunate enough not to have to deal with insurance companies or rattle cages.

Maybe once or twice, but it was just one phone call and it was taken care of.

Susan said...

God Bless you dealing with insurance. I have been through it and it is the most exhausting and frustrating experience. On the other hand, my sympathies for the shingles pain. I have watched my father suffer and my sister-in-law, so when my doctor suggested the Zostavax vaccine, both my husband and I got it. Our insurance paid it but the hassle was with the medical clinic who didn't want to accept the insurance money. Don't ask, it is unbelievable. Eventually, all was accepted and no reaction to the shot. I try to let people know that the shot is available and it is good to get anything that might help. Good luck.

The Blue Ridge Gal said...

I worked processing medical claims at one time.... my manager would do WHATEVER possible to NOT pay a claim... I hated my job. It came to a point where I would tell the insureds over the phone what was going on... that the insurance company was in financial problems and that their claim would most likely never be paid... NEVER work for a company that has their medical insurance listed as 'self insured' That means that your employer is the insurance company and coverage is most likely limited. Like I said... I hated my job.

Di
The Blue Ridge Gal

Hope your pain subsides... how unfortunate for you. :-((

Doreen said...

I wish you all the luck with this situation.

I too battle with shingles..they are horrible.

Feel better.
:)doreen

Jen said...

My son had a birth injury that left him partially paralyzed for a while. He needed lots of physical therapy for the first year and also a $5000 piece of specialized medical equipment to prevent a certain side-effect. Insurance denied the claim, even though to NOT correct the problem as an infant would result in years of additional treatment and maybe hundreds of thousands of additional dollars of cost. We were fortunate that we both could borrow the money to pay for it and had a kind of insurance that let us pay for the equipment and still file an appeal (some insurance if you pay you lose the right to contest). After 3 years I won the appeal and got full reimbursement, but only because I am a former lawyer and knew how to do major case research and threaten litigation. If we had not done this for my son before he was 8 months old he would have faced a lifetime of problems and maybe hundreds of thousands of dollars of additional treatment. All for want of a $5000 piece of equipment... Ridiculous! (PS, he's fine now. Just a little left-side weakness every time he grows). No thanks to the insurance company!

Vee ~ A Haven for Vee said...

Fortunately, I have no personal experience. My parents have horror stories.

When my mother came down with shingles, my sister (the nurse and every family should have one) was able to tell her just what it was and send her to the doc stat where she received medication to stop it in its tracks. So, if anyone comes down with an unexplained rash, painful to the touch...get thee to the doc's right away.

May you slay that dragon with one fell swoop, Suzanne. I hate to think of your having to be on the line with an insurance company for the day.

Joanna said...

I'm in charge of our health insurance here at work. We have Cigna insurance and we're also in a municipal administrative group that oversees our Cigna plan. Our Cigna service and plan have been excellent so much that I also carry Mike on this plan which costs us $600 a month ie why we have a tentant. All of our preventative stuff is 100% covered including the full colonoscopies. Usually when employees are frustrated it's because they are not familiar with the plan, there are strategies such as staying "in-network" etc. I have found in health ins, that you get what you pay for.

I tell them, "before you seek out a dr, specialist, hospital, etc to let me know, so I can help them get on the right track of the health ins journey.

Believe me, I understand there are many horror stories out there, I'm one of the few lucky ones that has an excellent plan.

We've had a couple of employees here that have had onsets of shingles, I can't imagine the pain. Some break out in rashes too I think.

Take care Suzanne.

Anonymous said...

Our medical office has to deal with this all of the time. The meds help the patient, the pharmacy wants to give it to the patient. The stink-o cheapskate insurance companies try to make it as difficult as possible to agree to paying for the meds. We've had some that say a patient has to try 4 other cheaper meds for same condition. If they don't work they'll pay for the one Dr. wanted to prescribe.

Arlene said...

Not a horror story but so frustrating. I fact, I blogged about it yesterday..if you are interested. Just SO DANG FRUSTRATING! I am so grateful I don't have to be a dragon slayer...best of luck to you. Hope you are back on meds and up to speed soon.

bv said...

oh, fw, i was worried about you! i, also, have had to be the dragon slayer and i am good at it.our son also had a transplant-heart-and over the years ins got tougher and tougher. it got so we had to fight everything and as you know transplants are pretty specialized. the trick was getting past the $6 idiot that answered the call. hope those drugs find their way to your house today!
bv

PatQ said...

I'm so sorry you're not feeling well. Shingles are supposed to be very painful from what I've heard. Hopefully you'll get your medicine soon.

Marilyn said...

What is going on around here with shingles and the pox?
So many women are suffering from one or the other, I just can't understand it.

My Grammy had shingles that even after the virus itself had passed caused her incredible pain the rest of her life. Neuralgia, I think is what they called it.
I would apply Lidocaine patches to the area that bothered her the most and it worked quite well.

Insurance sucks.

I hope everything gets straightened out soon

Cindy La Ferle said...

You make some excellent points here about the insurance issues. I've heard this same complaint from my doc in my own community. As you put it:

"An acquaintance of mine quit his medical practice in disgust saying, "I struggled through many years of medical school and training to treat patients NOT to spent my entire day battling with insurance companies"...

I hope you feel better, Sue!

Liane said...

Sorry to hear about your hassle - I hope you're feeling better soon. About two years ago I went for a routine eye exam and it took about eight months for the insurance company to pay the bill. I had paid my co-pay, and I had to call them every other week. Every time I called I got a different person, or they told me the claim was not entered in the computer. I document every single conversation and wrote a three-page letter to the district regional manager of the insurance company. I sent the letter certified and it wasn't long after that that the bill was finally paid.

StitchinByTheLake said...

My brother had shingles that affected his throat and ear. He still cannot speak above a whisper and it's been over six months. They told him they hope he can speak again after a year or so - it's a terrible disease. I take Celebrex for arthritis but my insurance won't pay for it. Not one penny. If I take it twice a day like my doctor recommends it's $220 a month. Consequently, I take it mostly once a day and still have some pain, but manageable pain. I've tried other medications, several in fact, but Celebrex works best for me. Insurance companies are in it to make money and that's ok but they could still make money if they were paying for all prescriptions doctors ordered. blessings, marlene

KatKit13 said...

I used to spend 5 days a month on the phone with the insurance company fighting this claim or that one.

But here's the ugly secret in Insurance Land. Autism and related syndromes are technically neurological disorders. BUT, they're treated behaviorally - thus, although they all SAY they cover it, they don't.

I've spent tens of thousands of dollars on psych bills - and am still paying.

hope you get your meds soon. Gentle hugs.

Kara S. said...

I am so sorry you have to deal with the insurance company. Phone calls like that are never pleasant especially when you don't feel well. Perhaps the only thing worse than insurance companies is workers compensation. It's a mutated form of insurance that makes life a living nightmare. We often have to wait in excess of 6 months for approval for anything related to my husband's care and even then that's with lawyers, mediations, hearings and everything else. It's frustrating that insurance companies think they know more than the doctor who prescribed the care. And some suggest that nationalized healthcare is the solution...

Jody Blue said...

I was denied by workmans comp. I wonder how they sleep at night. I hate jumping threw all of the insurance hoops. Hope you are on the road to recovery soon.

J'Ollie Primitives said...

I worked as a nurse in a "self-insured" hospital. The collections department, which shared the office space with the insurance processors, would send a collection notice prior to the insurance claim being processed. Un-freaking-beleivable. I fortunately am blessed with good health and I did NOT have to deal with them often, but those that did were tremendously frustrated, to the point of going to the hospital president. Not that anything improved (five presidents in five years speaks for itself).

Ruta M. said...

All this talk of insurance leaves me horrified. One of the good things about living in the UK is that we have our National Health system. A few people pay for private health care or have insurance but 95% of the population use the NHS. Money is taken out of every pay packet,I checked mine and it is about 7.5%. If you see your doctor and need medicine you pay £7 for each prescription, the cost was effectively doubled recently as now you can only get 1 instead of 2 month's supply but children and people on welfare don't pay. The only money you pay in hospital is the car park charges and (optional) a daily charge for a personal tv/internet/phone call system that a private company has installed in many hospitals. The drawback to the NHS system is that not all treatments are offered and you may have to wait for treatment though the target is currently no more than 6 weeks from first seeing a consultant at the hospital. It may be much longer for things like hip and knee replacements which though debilitating are not life threatening.The system seems to work fairly well and I can just imagine how much stress it would put on families having to deal with insurance companies or wondering if they could even have the treatment. At least there is none of that here though you do see cases on the news where drugs or treatments are availble in other areas or countries that are not availble for some people. They seem to have an even better system on the continent which is a combination of insurance and puplic healthcare but I don't know exactly how it works. The dental system is more of a minefield as NHS care is carried out by private practices and is limited and inferior to the private treatment available. Eye tests are free for children and those on welfare and there is a set charge for the rest of us. There are cheap NHS glasses but you would expect to pay £50 - £200 for a pair of glasses depending on the style of frame and the extras you have done to the lenses.
I hope that you get your pain mangement sorted out soon.