OMG...insurance people make me sick. They almost put me back in the hospital

so I was released on the 27th..given a huge page of meds...

insurance refused to fill one since there wasn't a special note from the doctor...


turns out that is the ONE medicine I most critically needed.

Saw the gastro doc today and he was PISSED that I was getting hassled


I was in so much pain for the last 4 days almost landed me back in teh hospital


The gastro doc gave me a sack full of the medicine that insurnace deemed I didn't need which if I had been taking since my release from the hospital, I would not be having as much pain as I am having

Shame on you, putting your desire not to writhe around in agony ahead of the insurance company's profit margin.




Seriously, I'm glad that your doctor stepped up and helped you out. Has he had any contact with the insurance company?


In any case, I hope that you feel better soon. :pals:

Battling insurance companies when you are sick is the last thing you should have to do.
Hang in there, hope you feel better soon.

They get called all day, every day, from pharmacists telling them, for the thousandth time, that they need to prior authorize. They are arrogant and since they didn't have to do that before, they make you suffer and get pissed at the pharmacist. Not the insurance company's fault, it's the doctor's fault.

but one of his partners...

when he came in my hosp room and then left, hubby and I looked at each other and said there was a reason he did sunday rounds...

we called him the night I got home after the insurance refused and he said it would be okay to be without the meds till I say his partner...my gastro doc.


my gastro doc was PISSED

said if I had waited one more day...back to the hospital I would go


I tried to get them to do it anyday but monday as that is the 1st teacher report day

doc said friday was too soon as I wouldn't have time to do the cleanse prep and if I waited longer than Monday I would be right back in the hospital

permission to treat his patient the best way he can.

I work with a guy who recently had to rush home to England as his mother was very ill and not expected to live. She did pull through and he came back just astounded by the treatment she received from the NHS (he decided he'd been here too long and had developed a bad attitude toward national health care). He said what amazed him the most was - the doctor made the decisions, including how long to keep his mom in the hospital. None of that if this is what is wrong you get X number of days and not a minute longer.

...it will be a necessary evil if we get public option or single-payer, too.

Like it or not, neither the insurance companies nor the government can afford to pay for every procedure, test, or med that a doctor might order. That's why some of the more specialized and expensive things require preauthorization.

There will always be a bureaucrat standing between you and treatment unless you're footing the bill yourself.

he'd only have one outfit telling him how to treat his patients and from what he's heard, the national plans are easier to deal with and have a better grasp of what is and isn't necessary. If nothing else, it's easier for the doctors to know what they can and cannot do when they're only dealing with one bureaucracy.

As I said, my coworker while dealing with his mother's doctor in England never once had the doctor say he had to waste time checking with the NHS. This was an elderly woman with a head injury and several tests were run more than once to keep track of what was going on - as well as keeping her in the hospital past the point when she would have shuffled off to a rehab or nursing home facility in the states.

Outside of the annual preventative tests, my insurance (Cigna) requires that a doctor get their permission for every stinkin' test. For that matter, even though they're suppose to pay for the preventative tests, my coworkers who have had them this year have had to fight with them to get the claim paid.

Of course, Cigna's CEO is retiring at the end of the year and they have a golden parachute to pay for - something a national plan wouldn't have to worry about.

Doctors treat patients on lots of different insurance plans, each one with different formularies, each one with different exceptions to the formularies, each one with different procedures to get an exception (if one is even allowed). To make sure there are no glitches, the doctor needs to know which plan you are on, what the formulary is for that plan, which drugs on the formulary are only there conditionally on that plan (even if they are unconditionally on every other plan), what hoops need to be jumped through to meet the conditions for that particular plan, if there is an exception process for drugs not on the formulary at all, the plan what that exception process is, whether your plan allows you to receive drugs not on the formulary but pay a higher price, and whether you are willing to pay the higher price, and finally - whether state or federal law imposes additional prescription restrictions.

I expect my doctor to know what is medically appropriate, and what the law requires. If he screws up on the minutiae of insurance nonsense - well there is just far too much plan variation and room for bureaucratic error for me to attribute the inevitable mistake to arrogance.

when DU apparently went down intermittently.

Now that I see the drug in question, I feel even more strongly that this was not doctor arrogance.

I have reviewed the formularies for at least a dozen insurance plans, including most of the biggies, for this very drug and its chemically identical companion drug Pentasa (which my daughter has been on for 15 years). All include both in their formularies, since even though they (Asacol and Pentasa) are chemically identical their delivery mechanism targets different areas of the gut for treatment so they are not interchangeable.

The MOST restrictive formulary I have encountered requires that it be prescribed by a gastroneterologist. No prior approval is needed based on any of the formularies I have reviewed - and in fact would be highly unusual, since they are the GI equivalent for treating IBD to using amoxicillin to treat bacterial infections. They (5-ASA drugs) are the first line of treatment (along with sulfasalazine - which the body breaks down into the same chemical); other treatment options later may require approval, but virtually every person diagnosed with IBD is initially put on a course of a 5-ASA drug possibly supplemented with prednisone.

If I were a GI doc, it wouldn't cross my mind that prior authorization would be needed for the prescription - any more than it would cross the mind of a GP to seek prior authorization for the use of amoxicillin, since it would be extremely unusual and unreasonable for an insurance company to require it.

Out of professional curiosity (I'm a med student interested in GI).

I have had two rounds of it today and my pain in the colon is MUCH less now

... up. Depends on your health insurer, I believe. You'd have to check with both your insurer and pharmacy, and get the cooperation of your doc if it works out that way.

Mr. H takes a regimen of drugs including something called 6-MP (6-mercaptopurine) that have put his colitis into remission for quite a few years now. His immune system is somewhat compromised by the meds, but he was pretty desperately sick for a couple of years before getting diagnosed correctly and treated appropriately.

Best of luck, greenbriar; bowel disease is really no fun. :hug:

Hekate

Every formulary I have ever reviewed (and I have reviewed LOTS) includes all of the 5-ASA drugs (Asacol, Pentasa, Rowasa) for IBD. Even though they are the same chemical, the release mechanism is different in each so they are not interchangeable. All that has ever been required by any I've reviewed is a diagnosis of UC or Crohn's.

It's like you have to be a warrior just to get what
we pay for .