Category Archives: insurance

Denied…

I am… lost… scared…livid… frustrated…

Probably not this month… Should be tomorrow but probably not this month…

I have been on Orencia INFUSIONS (that’s when they run an IV into your arm and deliver the meds in the infusion center) for eight years (a little more than 8). EIGHT YEARS… eight years… Six and a half of those years has been with the same insurance carrier… before they got acquired by a drugstore chain… one I’ve had issues with before because my stupid doctors refuse to write my prescriptions in the way the drug store chooses to be able to fill them… and yes, it is THEIR CHOICE to not be able to fill them the way the doctor writes the scripts.

Yesterday I got a letter in the mail telling me that my infusion (the one that was supposed to be tomorrow) was denied. The decision was made in August (woman on the phone let that little gem slip), the letter was written September 8 and postmarked September 9 in Arizona. It took six days to get to Ohio from Arizona.

To start with… it took six days to get me the information that the infusion that I start to really need by four or five days before the 4 weeks are up would be denied… it was supposed to be 9/16. It’s not yet cancelled but it probably will be today because… yeah…

The USPS couldn’t get it to me in less than 6 days. Good thing they are being way more efficient now that we have that shiny new head of the postal service… sigh…

I called… I called the clinic to see what they could tell me… they are working on it. THEY sent the follow up paperwork a week ago when they got the notification that after 8 years the insurance company thinks maybe I should just do things differently now.

I called the insurance company.

I got a very nice man that commiserated with me, but who had to put me through to the mega drugstore chain who owns them and who decided that suddenly they need more information.

At that point I became a very stupid four year old who needed to be patronized. The woman on the phone explained four times that they need more information. More papers need to be provided before they can decide again whether or not my meds are justified. After I got pissed and told her that I’m not a stupid idiot and that I READ on my letter that the doctor needs to provide more information and that, no, indeed, I did not need her to read me the letter again telling me that they just need more information and that I can file an appeal.

I snarked at her. I snarked hard.

She finally coughed up the information that the denial is typically because the doctor hasn’t prescribed the maintenance meds in such a way to ensure a 90 day supply… of IV infusion meds… that get administered in the clinic every 4 weeks… and have been for 8 years.

I can file an appeal.

That will take 15 days for the first level… then they will send a letter… which will make it 22 days if past history is anything to go by… letting me know if it is approved or again denied… at which point I can again file an appeal… and another three weeks later (that makes my 4 week infusion at worst 10 weeks out unless it is completely denied then suck farts old woman).

And all of this came two days after I watched someone dear to me drink a Pepsi… She has RA. She is finally (after several years… after MTX and plaquinil and enbryl and weaning herself off of 7 years of prednisone) pretty much controlled. Her hands aren’t working “right” any more and she has to pick up her Pepsi bottle with two hands to drink it because she can’t physically pick it up with one hand any more.

All of this while I sit and examine the nodules on my fingers that so far aren’t getting any bigger.

All of this while my fingers and toes are feeling like someone has poured hot ground glass into the finger joints and the joints where my toes connect to the big part of my feet.

All of this while hospice.

All of this while trying to hold it together

All of this… all of this… all of this…

And you know, <sarcasm> stress certainly doesn’t make any of this worse and it certainly doesn’t trigger a flare and it certainly doesn’t make me fall apart</sarcasm>.

I have to take walks with bear. It means too much to be able to push his chair all over the neighborhood and spend evenings out and about together. No matter what it takes, I have to push him on our walks. No matter what it takes. Time is so short and so precious… I have to… we have to… no matter what. What if the last walk was the last walk? What if… what if…

AprilJoy
9/15/2020

Pre-existing Conditions

069

No, mom, the picture isn’t from now, it’s from a couple years ago… just making a statement.

Okay… let me start out by saying I’m trying really hard not to over react. I’m trying hard to think that, even in politics, there has to be some logic involved, some degree of common sense.  I’m trying to believe that a country that has progressed so far in the past dozen or so years can’t possibly slide backwards so far so fast.  I try.  I really try. I want to believe that my daughter (who has kidney stones and epilepsy) won’t be cast adrift.  I want to believe that my son with sjogrens will likewise not be put on his own iceberg.

That said… trying hard doesn’t keep me from being terrified.  I’m terrified.

I read pre-existing conditions.

I read caps on coverage.

I read the rhetoric and the realities.

If there is a million dollar cap on lifetime benefits… and I ONLY get my orencia infusions… those magic biologic treatments that keep me functional… at 10,000 billed to my insurance a month… that leaves me with just over 8 years.  8 years of being able to be a functioning tax paying contributing to society citizen.

There has to be an irony in the fact that 8 years will take me to the maximum possible term that Trump could see.

And I am one of the “lucky” ones.

I hear the people in the infusion center talk about what EACH of their treatment actually “costs” if it isn’t covered.    Fifty thousand dollars a week for one treatment.   They get to live almost 6 months (because their treatments are keeping them ALIVE not just keeping the hot glass shard feeling out of their fingers or their fingers pointing in the same directions, or their knees from being the size of volleyballs).

I’m trying to not be reactionary

Acne is a pre-existing condition

Acne

People who had cancer 15 years ago and are not clean and clear… they have a pre-existing condition.

And don’t even get me thinking about how much the fact that a woman is born with the wrong anatomy to matter.  <<it’s been a LONG exhausting week and I might just tell you>>

 

I don’t want to be reactionary… but…

States could apply for waivers that would allow insurance companies in their states to do three things: 1. Charge older people more than five times what they charge young people for the same policy; 2. Eliminate required coverage, called essential health benefits, including maternity care, mental health and prescription drugs, that were required under the Affordable Care Act; and 3. Charge more for or deny coverage to people who have pre-existing health conditions, such as cancer, diabetes or arthritis.

The waivers could also impact people with employer-based insurance, because insurers could offer policies that have annual and lifetime benefit limits, which are banned under the Affordable Care Act, and some companies may choose those policies for their workers to lower premiums.

Let’s face it… I’m really scared.

I’ve written my senators.

I’ve considered stopping my infusions because they will cost more than I make

I’ve considered moving to somewhere that will allow me to afford to exist.

Yeah… not being terrified and not being reactionary isn’t really working for me so much right now.

Hitting Insurance Thresholds

So, I got a phone call this past week.  Apparently the insurance company (or the company I work for) noticed that I hit a magic threshold in their reporting system and it triggered a call to see if there is anything they can do to make my life better (read cheaper I think).  I talked to a very understanding nurse who looked at my medical record and said… Oh… you have rheumatoid arthritis and you are taking Orencia.  I think that is probably what triggered it.

Duh

It’s like 8000 dollars a month between the infusion center bills and the medicine.

It’s difficult to think about the fact that this is going to continue for the rest of my life to one degree or another.  It’s sobering.

I keep thinking about the notification from the drug companies saying that they will help with the cost of the medication if you have private medical insurance.  If you don’t have insurance, the cost is so horrendous.  I think about where I am and the fact that I have a good job that keeps me in insurance.  I don’t know how people deal with the pain if they don’t have the facility to pay for the drugs that stave off the damage and the pain.

Updated: August 20, 2014
Author: Figment of Fitness
Keep the dreams alive