medicine vs my insurance co.

[Midge Rollins]

Let me vent. For 5 yrs post transplant I have been on 2 cholesteral lowering medicines. One a Statin that works through the liver, the other Zetia that works through the blood. Each medicine works differently in lowering cholesteral. For 5 years my insurance has covered the Zetia. It does come with a higher Copay but it has worked. This year at my annual post transplant appt. the Dr.s decided I needed to switch to a different statin drug along with my Zetia as my LDL needed to be higher. Also in a new study my Lipo proteins were twice as high as they should be which indicates a higher risk for heart disease. Well, my insurance has denied my Zetia now saying I have to be on 3 different statin medicines and show they fail before they will let me have Zetia again. Here is the deal transplanted hearts have no nerve endings thus we cannot feel chest pain, and we have to have an angiogram annually to check our arteries. My insurance company apparently wants my arteries to clog and let me have a bypass before they can give me the Zetia. My transplant physician has appealed but was told that is just the way it is. I also am waiting for a blood pressure patch to be refilled that they are evaluating. The whole issue is driving my BP up and I can feel my arteries clogging. I really do not appreciate insurance companies dictating what medicine is best for me. This decision was made by a clinical pharmacist not a physician. Thanks I have vented now and I will go write my letter to insurance on how they are compromising my health care. GRRRRRRRRRRRRRRRR

[Cynaburst]

Go get 'em Midge! I hate that these insurance companies make such arbitrary and stupid decisions. I had a fight with mine last week about the CT scans that I have to have to follow my brain tumor. They would not authorize one. I guess that they would prefer I die from the tumor that they won't let my doctor's look for. Thankfully, they did come around after the doctor called and explained. I hope that they relent in your case as well.

All I can say is the better you document your case the better off you are.

[THW]

Grrrr is right, Midge. I've had my share of insurance battles and know it can be so frustrating, especially to think of their ignorance in making those important decisions about your care. As Cyn says, 'go get 'em.' We're cheering you on.
Theresa

[Largehearted]

One would think that MDs should be making the kinds of decisions that insurance companies make these days.

For a while I tried to sell insurance. We were told in training that we can "never forget insurance companies exist to make money." No matter what they say about taking care of you their real purpose is to make money, thus they make these kinds of decisions.

I didn't last very long in that business.

Midge I hope you can what you need soon!

Peace,

Leon

[gfox42]

Wow. Just when you think you understand the limits of greedy idiocy, you learn that they're far broader than you dreamed.

Gordon

[mbcube]

Midge - May I suggest you take some boxing lessons from Pam and teach them a lesson?!
Its not like you the run-of-the-mill patient! Jeez, what are they thinking here!

[EmilysMom]

Wow. Unbelievable. You had a heart transplant paid for, and then 5 years of HTx med. And then this is what they decide to cheap out on? Wow. It makes no sense.

[Cynaburst]

Midge - You should tell your story here. Maybe they will pick your story as an example of what is wrong with the health care system and fix it.



http://my.barackobama.com/HealthCareOrganizing

[Pam Alexson]

My goodness... this is horrifying and sadly more typical then it should be for any patient.. let alone a heart transplant patient.. If you need me to cold cock someone just let me know I am still ready and better able these days. Sorry you have this battle to wage.. THEY ARE IDIOTS!!

Pam

[Laoshur]

Midge, this is, as we all know, ridiculous! Some time ago I think I posted what a friend who had worked in a doctor's office filing insurance claims told us: Call the insurance company and ask them to send you an official rejection letter so you can file a complaint with your state insurance commission.

It works like magic. This friend told another friend of mine to do this when she was getting the run around on an insulin pump that her doctor had told her was essential for her survival. When my second friend called, the person answering the phone said she needed to check with her supervisor. Immediately the supervisor came on the line and said that a mistake had been made, the device had been approved, but the doctor had received the wrong information. Hmmmmmmmmmmm This problem had gone on for more than a year before this phone call instantly fixed things. The moral (?) is that the insurance company is not afraid of you and not afraid of your doctor but is afraid of the state insurance commission.

I hope you can get this worked out easily.

Rhoda

[shirleymahoney]

Rhoda

That is exacty what I did, when I finally went to see Dr. Maron 4 years ago.

Shirley

[Toogoofy317]

I am facing this same dilemma with psych meds. I have steroid induced mood disorder and PTSD. In the past I had been treated with Abilify I did really well on it to the point I went a year without it. I cannot tolerate SSRI's we had already tried two with disasterous effects that almost cost me my career and if I hadn't sought help maybe my life!

My psychiatrist tells me that we have to fail three psych med before they will cover the Abilify! Well, I begrudgingly started a med called celexa and just like the other two times I went off the deep end. Just woke up one morning saying screw this no more meds no more doctors I'm done! This is not me I always take my meds religiously see my doctors and do what I'm supposed to. Next day found myself going 90mph on my motorcycle no gear. So, I had two weeks of sheer he double hockey sticks getting it out of my system! When I talked to the psychiatrist again she said well time for the next med. "oh no! we are not doing another SSRI who knows what will happen this time. So, she is trying me on Rememron to see if that will qualify and then hopefully we can then go to the Abilify!

I'm disgusted with insurance companies. but, I doubt universal health care is the answer either!

Mary