June 21, 2007

A Medical Complaint (And An Ill-Formed Analogy)

I have a bone to pick with my medical insurance company. Allow me to illustrate.

Let's say you're single. One evening, while out to dinner with friends, you gaze across the room and catch the eye of another. The gaze lingers, motivates you to get up and introduce yourself. After searching long and hard, dating and breaking up, you have, at last, found someone who seems right. You date, you move in together. You and this person just fit. You share many of your loves and preferences - romantic comedies, death metal, walks in the park, sushi, white-water rafting, malt liquor, whatever - but not too many to make that other person an annoying mirror image. Eventually, the question is popped and wedding plans are made. Standing in front of friends and family, expecting nothing but happiness and fulfillment along with the inevitable rough patches, you exchange vows. And towards the end, just as the priest is finishing the you may now kiss sentence, a group of black-outfitted commandos make off with your true love and replaces this person with a fairly close look-alike, someone not quite as hot, who prefers smooth-jazz to death metal and cheap wine coolers over malt liquor.

I've suffered from depression for somewhere north of 12 or 13 years. At its worst - during and immediately after college - it was fairly crippling. Now it's most certainly not. It's not, in fact, something anyone would ever guess unless I volunteered that information. I credit a little bit of therapy and a little bit of medication with the improvement. The other day, I went to pick up my monthly prescription. Instead of the usual $10, the meds rang up to a healthy $25. Not quite what I was expecting. I was about to call my insurance company when I received a letter. It said something to the effect of:

Dear Worthless Customer:

We've noticed that you take the prescription medication Scrotozylobaneva. We would like to let you know that there are other treatment options such as Yourmomsawhoresia. And even though we're just sitting here crunching numbers with our thumbs up our asses and the closest thing to a medical degree we have is that one drunken med student we banged out in college, we're making a unilateral decision to charge you more if you don't switch to the medication we want you to take.

Bend over 'cos you have no choice,
Monolithic Insurance Company

Are these fuckers for real? I've worked long and hard to find a solution that works for me. And while I like to think that even without medication I'd be just dandy, I've identified and harnessed something that provides some part of the equation, something that helps me feel as though the world is not going to swallow me whole. And some idiotic number-crunchers, without the benefit of a medical degree, want me to pay more for the privilege of feeling better, feeling healthy, feeling sane?

Surely you see the parallel between this and my little dating scenario, right? If not, I'll admit it was poorly executed. The bottom line - it's bait and switch by someone with no personal stake in your life. And it ain't right. I realize there are people in the world - hell, this country - who don't even have access to potable water much less medication and access to medical care. But if you've going to bend me over, I expect the courtesy of a reach-around. Even the most disadvantaged should be able to count on a reach-around. If not, what is society coming to?

Posted by Chris at June 21, 2007 7:12 AM

nothing like getting fucked in the ass without the benefit of vaseline!... we switched insurance companies... went from $5 copay to 15, then back to 10...unless we get a generic...then we are back to 5....how the hell do you figure that one out? but.........there is hope...maybe... if you have the famous walmarts close ....they have like 300 meds that they will fill for $4/month... and target and some kmarts will also follow suit... the only reason i know this is because enough of our employees bitched so that the company did some research and sent us all this little "information packet" on "how to save on meds".... since it is ongoing...why not try merck medco and get 3 months at a time? talk to your doctor (ask about samples) talk to your pharmacist, talk to your employer...
i wish you luck on that one!

Posted by: the unicorn at June 21, 2007 7:47 AM

As someone who knows first hand that not all depression medications are alike, I am appalled that the insurance company would deny one medication and not another. And yet, I'm not surprised either, sadly...

Posted by: suze at June 21, 2007 7:58 AM

If it's any consolation, the EXACT SAME THING happened to me last week when I picked up my birth control pills, except I didn't get a letter. They just cost $20 more. I had to call the dr., who called the insurance company, who told the dr. that they preferred patients take X instead of Y now. But I've taken X before, and it makes me nutso. So I have to pay $20 more per month for Y or screw around to find something else that works that doesn't turn me into a raving, sobbing lunatic that's cheaper.

I feel your pain.

Posted by: Alissa at June 21, 2007 8:04 AM

That sucks. You should ask the pharmacy how much the presciption would cost if you paid cash? Often drugs are cheaper than the higher co-pays that insurance companies Charge. The pharmacy won't tell you that becasue they make money. Seriously you should ask.

Posted by: William at June 21, 2007 8:10 AM

Just wait until you have Medicare if you think you have a problem now. (Although I do sympathize - I know exactly what you mean. It's the bean counters at their very best.

My husband is doing without 2 medicines, one for anxiety and the other for stomach problems. Humana (the Medicare provider) doesn't cover them - period. One costs $300/month; the other $500.

So he does without. The anxiety and stomach problems make him sick enough to be hospitalized. Once he's in the hospital, those two drugs are provided. He feels better, gets out, discotinues the meds, and gets sick again. Back to the hospital one more time. Lather, rinse, repeat.

The hospital bill each time has to be way up in the thousands of $ which is covered by Medicare along with all medication provided by the hospital so long as he's an inpatient. It could be avoided by allowing the medicine he needs.

Posted by: ann adams at June 21, 2007 8:12 AM

Chris~don't know if your Doctor has already done this, but there's a form that he/she can fill out and submit to the insco that states that other meds have been tried, didn't work, this is the one that works, and the insco will pay. Good luck

Posted by: Dawn at June 21, 2007 8:26 AM

Chris, I feel your pain, happened to my hubby too regarding his stomach medicine. We had to try three over the counter medicines before we found one that worked. It sucked! He was sick for over three months before we found something that worked. Sorry you have to go through this, take care.

Posted by: linda at June 21, 2007 8:41 AM

Chris, I feel your pain, happened to my hubby too regarding his stomach medicine. We had to try three over the counter medicines before we found one that worked. It sucked! He was sick for over three months before we found something that worked. Sorry you have to go through this, take care.

Posted by: linda at June 21, 2007 8:42 AM

The analogy's pretty accurate and probably a big part of the reason I'm still single. Bigger than I let on sometimes, anyway. I think you should call them on it. Make them justify their actions in writing, even though it'll doubtless be hogwash. Look at it as forcing them to give you the reach around you deserve, whether they like it or not. A small victory is still a victory.

You might also look to your therapist for ammunition...if he/she sees the name of the drug they're pushing and says, "Um, actually, that's a horse tranquilizer", you may have grounds for litigation.

Posted by: You can call me, 'Sir' at June 21, 2007 8:43 AM

not sure what big giant conglomorate you have but call them and ask for a case advocate (or something or other). with Cam and all his medical issues (surgeries, procedures, meds, etc.) we got one and she explained that when forms come through (such as prescriptions) the people in the office only see a code number. they never see the reasoning behind the code number. in my case i had to start calling and explaining why we needed procedure ABC and suddenly we'd get letters in the mail extending us coverage. we were the first people in our state to have a certain therapy approved for coverage... simply because i called. i've found that with the first call it's okay to play dumb and if there are other calls required after that you can get bitter and pissy.

Posted by: monique at June 21, 2007 8:46 AM

Wow, that's fucking horrible. I know what it's like to play around with different meds until you find The One that works. Not Fun.

I also suggest seeing if there's some way your doctor can help you out here. I don't know how what they're doing is even legal. Fuckers.

Posted by: Fraulein N at June 21, 2007 8:49 AM

Or how about if your pregnant, and you depend on your husbands insurance. He switches jobs, and you are forced to switch insurance wit him, even though the insurance is crappy... only because no other insurance company will insure an already pregnant lady. That, and you find out that after paying out the ass for this insurance you have a very high deductible and they only pay 60% after that. It sucks donkey balls, especially when you consider how much doctors charge for having a baby. I hate insurance.

Posted by: Corinne at June 21, 2007 8:50 AM

Ouch. I have the same problem with my anti-depressant. Apparently my insurance company has labeled it a "preferred" brand and I get to pay twice as much. Asses.

Posted by: mingaling at June 21, 2007 8:51 AM

How sad it is that so many have experienced this exact issue. When did the insurance companies get so powerful that they are able to decide what meds work best for us? Sad...

Posted by: daisy at June 21, 2007 8:52 AM

Chris, this almost has to be illegal. I say SUE!

Posted by: Candy at June 21, 2007 9:01 AM

a classic example of what's wrong with the healthcare system in this country. Good luck w/ that.

Posted by: kalisah at June 21, 2007 9:08 AM

I think you should call Fox News (or whoever you fancy) and see if they will do a story on this. Complete with actors simulating your dating scenario. Cause this sucks. And yes, take the advice of the others and see if your doctor can help you out with a letter (or the reach around perhaps).

Posted by: alfredsmom at June 21, 2007 9:09 AM

What, what, what?! Living in sin before marriage?!

I've never had anything like that happen to me (because thankfully, I can stomach generics), but it does seem like a class action lawsuit waiting to happen.

Because people can be very sensitive to minor differences in some meds, like SSRIs for example.

Posted by: sunchaser at June 21, 2007 9:36 AM

Ugh! I'm so sorry. Anti-depressants are such a fragile balance. I feel for you. :(

Posted by: Hope at June 21, 2007 9:50 AM

If there's one thing you can count on, it is that insurance companies are assholes. And it is particularly irresponsible of them to do this with anti-depressants. There are some medications where it doesn't really matter if you take one brand or another, but anti-depressants have to be pretty fine tuned. Once you find one that works for you, you can't just blithely swtich to another one. They don't work that way. I'd see if your doctor can intervene. You should have him/her send a letter explaining that drug Y is the right drug for you, not their lame substitute. It can't hurt to try.

Posted by: bad penguin at June 21, 2007 10:01 AM

I agree with the sentiment of getting a medical professional to write a letter indicating this med is the only choice.

To make a point, you could go on the new med for a month and then have the doc write it up (assuming you haven't already taken the stuff... if you have, then just skip that part and have the doc write you a note saying that the stuff doesn't cut it for you).

And damn, you think $10 per prescription is reasonable? Move up here man.

Posted by: SciFi Dad at June 21, 2007 10:09 AM

It's complete shit what they'll do to make more money for themselves, because lets face it, they're not doing it to pass the savings onto the customers. Dicks.

I'm preparing myself for a huge fight when the time comes to get the Mini a helmet for his plagio. They love to not cover those. Because they thing it's "purely cosmetic."


Posted by: statia at June 21, 2007 10:22 AM

As someone who takes multiple meds for various and sundry conditions, I do feel your pain. However ... if you will bear with me ...

Whether health care is covered by private insurers, or by some future single payer (monstricity) ... this is an example of the system working. As the commenters above have said, there may very well be an appeals process available, with your doctor's documentation. However ... if there is ever to be any hope of controlling health care costs ... then you have to accept the possibilities that the payer (be it big insurance co or the gov't) will be second guessing the treatment plan, and attempting to control costs by helping guide people towards treatments that are proven to work (for most folks, at least) and are lower cost.

Since it's their (and all of the other contributors) money - someone has to be watching the check book! The flip side of this is to think about the "other guy" - who may be trying to get the luxury car treatment/med without first trying the proven and lower cost treatment options. Wouldn't you want the insurance company to try to contain those costs across the board?

And as long as there is a resonable appeals process to go along with that checkbook monitoring ... then I'm all for it.

Posted by: Airwick at June 21, 2007 10:25 AM

Hey Chris, long time no comment I know. Insurance companies are surely the devil. My husband is a pharmacist and hates them with much fervor. However you might want to look into this because the generic version of anti-depressants/anti-anxiety meds as well as most meds that HAVE a generic form are significantly cheaper for you as well as them. And they are the same thing. I know it probably scares you to think about switching but it's just the name that you are paying for, really!! I take medications for both and my husband feels completely comfortable with me taking the generics, I've never had any trouble with them. So just a little fyi, k. Good luck with it.

Posted by: Bethany at June 21, 2007 10:38 AM

...don't even get me started...

Posted by: sue at June 21, 2007 10:49 AM

I know exactly how you feel. Except in my case I was told that an OTC was just as effective and they would no longer cover my GERD meds.

Posted by: ari at June 21, 2007 10:58 AM

I was commiserating with you (and it -is- a bad situation) up until the last paragraph. At "Even the most disadvantaged should be able to count on a reach-around," I just cracked up. Hope things get sorted out soon.

Posted by: Laura GF at June 21, 2007 11:01 AM

Ok, first of all... those bastards, how dare they mess with people with that. and on the day of the premier of Michael Moore's new movie Sicko.

Now, I will tell you that Dawn up there is on the money. There is a form that your Dr can fill out to be filed. Should work like a charm, and also some insurance places will make you use the mail order thingy if you are on "maintenance" meds. Hubby had to do that for his diabetes meds.

Good luck fighting the dorks.

Posted by: Karen at June 21, 2007 11:07 AM

I'm seething just reading this, it took me a couple of goes to find the right anxiety medication (it's actually an anti-depressant, prozac) and there is no way I would change to something else, there's the side effects and withdrawal not to mention that a new medication might not work.

We don't have these kind of issues in Scotland (or the UK as a whole), the new Scottish government are looking at making prescriptions free for long-term conditions, wonder if anxiety and depression meds will be included?

Posted by: Katherine at June 21, 2007 11:11 AM

I pay $50 each month for my anti-baby prescription and every other month for my allergy nose spray. Sure, I could've paid a LOT less if I switch to whatever the hell brand they list. It took me years of trying different kinds and suffering a lot from massive nosebleed to suicidal mood swing to find both of these perfect medication. So I'm stuck with them. And I hate my coverage.

Posted by: oakley at June 21, 2007 11:45 AM

I too feel your pain. I not only had to fight with my insurance company to cover my anti-depressant (I not only take the brand name, I take the most expensive version of the brand), but I have to fight with the pharmacy every time they refill it because they keep trying to give me the "new generic" because it'll cost me less, and I have to tell them "NO. Do it again." Interestingly enough, last time I went for a refill, it rang up $50, I was all "the hell?" and it turned out that the newest generic would've cost me $50, when my brand name only costs me $35. Idiots. I wish you luck, I know how much it sucks being on the wrong medication.

Posted by: Judy at June 21, 2007 12:03 PM

Oh, Chris, the can of worms you have opened! We've been dealing with this BS with two different ins. companies in my household. Insurance won't cover Mom's shots of Procrit to bring up her red blood cell count because - get this - she doesn't have cancer, nor is she on kidney dialisys. She simply is in the beginning stages of kidney failure. WTF?

I recently had hernia repair surgery, and in order to take ANY kind of painkiller above Extra-Strength Tylenol, I need Zofran to kill the nausea I experience with Percocet, et al. The ins. co.? Would only cover NINE of the GENERIC pills during a THIRTY-DAY period! So that meant that I could either a)take a Zofran with my pain med every 4-6 hours as prescribed for a total of 36 hrs. (if you go on the 6-hr. side), OR b) I could take my pain medication twice a week with one extra dose thrown in for shits and giggles for the month.

I had to get on the phone in my pain-induced post-surgery fog and fuck around with the ins. co. AND my kind surgeon's office to get them to cover the fucking medication. They said it was too expensive, even the generic. At this point, I'll even take the generic -- just let me have it. It's not like I'm a drug-seeking fiend; I simply have surgically-induced pain that I cannot handle on my own and if I vomit from any heavy-duty pain meds, well, I'll just be UN-DOING any and all of the work my surgeon just did and my ins. co. paid for (well, the jury is still out on that... haven't got the bills yet). The bastards DID "OK" me for a 30-day supply of the pills (#90), but only after a day and a half of pissing around on the phone and my going without pain med for about 12 hours after being out of surgery for less than 36 hours. The thing is that I knew I would only need them for about a week and then I could switch to XS Tylenol. But what did they "force" me to do (because of their stupidity)? They "forced" me to pick up ALL FUCKING 90 of those pills at my copay price (hahahaha to them!)and 71 of them will be sitting in my medicine cabinet.

Anymore, having a medical insurance card is simply like having a "savings card" or whatever customer card the local grocery store has to give its "loyal" customers the "lowest price" on goods. Or like your Pet Perks card at PetsMart -- you can save a buck or two every now and again on your cat or dog's fave kibble. And? Usually what YOU need on sale at THIS VERY MOMENT was on sale LAST week or will be on sale NEXT week. Fuckers.

Oh, and while I'm at it - just exactly how is it that these people who do not know us from a code on a sheet of paper or the Average Joe sitting next to us can TELL us what prescriptions to take? I mean, why do we bother going to doctors? Should we just start calling up the ins. co. and saying things like, "Hey there. I am suffering from the FuckYouDisease and I'd like you to suggest a prescription to help me get rid of it. What's the lowest bidder, in terms of drugs you'll let me take? Oh, I see, the one that improves the clarity of my urine? Great! Send it on over!"

I agree with those above who suggested either getting a case worker and/or getting the doc involved with it. It's too precarious a situation to start fucking with it because the ins. co. wants to pocket a few pennies. Plus, they figure you'll either switch to their suggested drug, thereby saving THEM money OR they figure you'll just pay the $25 thereby GIVING them extra money... just because it's easier for you or they figure you'll think you have no choice. Fuckers.

Posted by: ironic1 at June 21, 2007 12:08 PM

Insurance companies suck...I've been going to physical therapy for my back because of the pregnancy getting it all out of whack, but they've cut me off because they "have studies that show I should be better by now"...pffffffffffft...they can take their studies and shove it!!! obviously they've never carried 35 extra pounds around and have not felt the damage that can result from said extra pounds...all I know is it cripples me and they don't care.

Posted by: Li'l Foot's Mommy at June 21, 2007 12:10 PM

Duuude, that's annoying. And so not right. My insurance charges me more if I don't get the generic (if available), but that sort of makes sense. This? Is just crack-headed. I'm sorry they're being such buttmunchers.

Posted by: Dawn at June 21, 2007 12:15 PM

Our insurance rates just jumped. Hard. And I'd be ok with that if we actually needed Western Meds, but we don't use them. We take the kids to the doc once a year and other than that, never see anyone in a white coat. SO WHY DOES IT SUDDENLY COST SO MUCH MORE?

Of course, the flip side is that I don't feel it's right for only the people needing medical care to have to shoulder all the cost, but I'm pretty sure this whole insurance thing is way out of hand.

Sorry then bent you over. Hopefully you can find a way to karmically f*ck them over.

Posted by: Elaine at June 21, 2007 12:23 PM

E will have something to say on this, for sure. Her health care, for just insurance, medication, and therapy, will run about $500 a month. That's excluding the additional therapy she has been recommended and wants to take, and also the medication and doctor's appointments for some other health issues she has going on.

Health care is one of my soapbox issues. It's absolute bullshit that people with insurance can't afford to use it (that's why I'm not in therapy or on meds even though I should be) and what's worse, that there are so many people in this country without, a majority of them children.

Bah! Bastards!

Posted by: Sparkle Pants at June 21, 2007 12:46 PM

My stupid insurance company just outright switched my medication to a generic brand of he same thing. Apparently they can do that? I just sucked up and didn't really think anything of it, except now I'm getting dizzy all the time. Strange.

Posted by: sam at June 21, 2007 12:50 PM

I would never suggest this to anyone in a million years because it is totally illegal, but...

I happen to know that you can get meds via the internet from Canada for almost a third of the price you would pay cash here for in the US.

You see, I had this friend...who's son needed a certain prescription filled quite badly and the insurance wouldn't cover it. And it's not even like there was another brand they would pay for...it was the only medication of it's kind.
AND she did have the doctor write and appeal the decision to the insurance company, but it was still a no go.
So my friend was going to just pay out-of-pocket but it was $400 per 28 day supply. She eventually had the exact same prescription filled in Canada, sent via fax, for $150.

Posted by: fauve at June 21, 2007 1:08 PM

oh my god, are they fucking kidding? that is UNREAL. especially when it comes to antidepressants. I've been on them for a while now, and I know what a difference an alternate med can make. Both positive and really really really negative.

The insurance refused to pay for the new chemo treatment my dad's dr wanted to switch him to, even though it was the only chance of prolonging his life. Who knows, he might have been able to come to my wedding. We'll never know.

you are right, I wouldn't have guessed. But most people would not have guessed about me either.

Posted by: jodi at June 21, 2007 1:26 PM

I'm with you. I've suffered from depression since college and doctors and insurance keep trying to talk me into switching to whatever med du jour tickles their fancy.

Posted by: Laura at June 21, 2007 1:31 PM

I totally hear what you're saying Chris. I also take medication of the mental health variety. My insurance company has screwed with mine twice now. This last time they decided they won't cover one of my meds at all anymore... they've removed it from their "prefer use" list so I either have to change or pay full price...which currently is $65 dollars a month. I think it's crap. We should be able to at least have the right to be healthy without it costing us an arm , a leg, 4 fingers, and an extra mortgage on my house.

It's really sad. Good luck. I hope that they don't mess with yours any further.

Posted by: Tammy at June 21, 2007 1:34 PM

I've had a similar thing happen... I had received a letter explaining that generic drug y was a perfectly good substitute for Brand Drug A - and that they had contacted my doctor and they all agreed so they switched it AT THE PHARMACY for my next refill... to one of the meds I am ALLERGIC to (noted in all of my records BTW)Well - my doctor and I had gone thru a long 2 year process to find this medicine for Acid reflux that worked - including allergies to most of the common (and cheaper) ones - so I knew that letter was complete crap. Happened to have an appt 2 days after I got it and showed my doc - dear lord he was pissed. We both called the ins co and ripped them a new one...that was fun!

Posted by: Sue R at June 21, 2007 2:14 PM

I totally commiserate. I'm on the same type of drugs and there is a fine line between what works and doesnt, and you dont mess with it when you get one that finally works. Between the weaning off and start up time for each new drug, the times in between can really mess you up.

Its a scary thought that the idiots they have making the ruling on these things dont take the HUMAN factor into consideration. Damn insurance companies, only out for the almighty buck.

My only comfort is in the thought that what goes around comes around, and those making these awful decisions will get theirs in due time. Unfortunately it doesnt help people like us now.

I agree with the person above who suggested to make noise via a tv station in your area. Maybe if enough people caused enough commotion, the thieves would be drawn and quartered for a change.

Posted by: 3jaysmom at June 21, 2007 2:49 PM


Posted by: ali at June 21, 2007 3:35 PM

Clearly you are all alone in this. I have never ever been screwed by my insurance company. Not once have they forced me to try a different antidepressant or insist I try generics. And by 'not once', of course I mean All the Fricking Time.

I disagree with the commenter who said generics are the same. I have not had nearly the same success with generics - for antidepressants or for thyroid hormone. They just aren't the same. And one time, I was actually taking an 'okay' generic but the pharmacy switched to another generic and I got sick. I now have to pay cash for my Synthroid because my insurance won't cover it. Luckily, it's pretty cheap (cheaper than the highest co-pay, ironically).

Don't mess around with your antidepressant, Chris. I finally had to resign myself to paying a $25 for the drug I like best.

Posted by: Trix at June 21, 2007 4:18 PM

been through this, but with b.c. pills. it is maddening.

on a wholely unrelated note, i was just reading your wife's archives and came across a post about pregnant dreams, which are crazy and vivid. that reminded me that i, crazy vivid pregnant lady, had a dream a couple of weeks ago about you two. apparently i magically stumbled across your last name, looked you guys up, and called you to ask you to dinner.

i don't know why, and i promise i'm not a stalker although you and now all your readers probably think i am.

running away now.

Posted by: b. at June 21, 2007 4:35 PM

My parents insurance company has been doing that to them for a couple years now...well mainly to my mom. Reflux meds, cholestorol meds, you name it. All to something that has had numerous complains made known by people we know. About the only one they've not made a recommendation to change yet is her thyroid meds, which costs a measley $16 in the world of Rx copays! Good luck fighting the insurance idiots!

Posted by: christina at June 21, 2007 4:40 PM

Insurance is a huge racket. A merciless. criminally-negligent and self-serving racket. Why do we pay doctors (who know us and have actually seen us) to make us well if the insurance companies are allowed to override that sound medical advice simply because it makes more money for them?

Posted by: wordgirl at June 21, 2007 4:59 PM

military medicine often works this way. If they have a contract with one drug company, that is who they carry at the pharmacy, period. I now just do the copay thing out in town so I can get what works. Luckily, the copay is low enough that it isn't an issue. meds are nothing to screw around with on a whim. I agree you should try to enlist the help of your doctor on this one.

Posted by: Annie, The Evil Queen at June 21, 2007 5:50 PM

So glad I live in Canada. And yet, the job I was working at? They found out I had depression, and fired me. Yeah, I'm a little pissed off and a little shocked and a little WTF?! But mostly hurt, I think, because they'd already said they were pleased with my work and then fired me based on a label. Yippee.

Posted by: Heather at June 21, 2007 5:57 PM

So here's my comment for some of the more rabid people:

Try NOT having insurance at all. It's a blast to pay for a real problem when there's no insurance around. I think our system is horribly messed up, but it is, in fact, better than nothing.

Trust me.

I've found enough phone calls, being a gentle but constant pain in the ass, usually fixes the matter, if it's worth the time to you. The doctor thing works, too. Big hugs to you. The Boy and I have been there, done that, and I think we have three or four t-shirts a piece.

Posted by: alektra at June 21, 2007 6:21 PM

--I used to work for one of those crazy number crunching firms and I know its easy to blame the insurance company but think of the bigger picture.
--If this is happening to so many of you as the comments would indicate who exactly IS paying full price for the brand name drugs?
--Why can't we even afford generics in this country yet brand names & better are sold in Europe, Asia & third world countries for penny's in comparison to what our tierd pricing schedules demand we pay?
--Why is it when I pay cash at my doctor (to meet my dedutible requirements that I pay less then what shows up on my claim?
--Its more than the insurance company; sure they started it with their stupid HMO's but think of this -- pharmaceuticals is the largest, most profitable and booming industry next to online porn and gambling in the world right now.
--I was/am in the same boat as everyone here but its more accurate to blame the ENTIRE healthcare system/scam in our country. Its your lobbyist and public representatives as much as it is the insurance company?
--Where does all that pharaceutical profit go? Capital Hill.... Insurance, pharmaceuticals, hospitals, HMO's and consultantcy firms would crumble if we made our system efficient and helpful.
Sorry Chris, maybe its time to fight back?

Posted by: chantel at June 21, 2007 6:57 PM

Ah, yes. Then you have to go through a month of crappy substitute pills and remember to tell your doctor to please start writing DAW on the damned prescription because otherwise they'll just give you generic despite your telling them that you're there for the SAME prescription of the SAME medicine you've been on forever, so why can't you get the SAME MEDICINE and not some arbitrarily chosen subby. I take some generic meds, but I'm weirded out by knowing that the same amount of quality isn't there.

I guess I'm pretty passionate about this.

Posted by: Jurgen Nation at June 21, 2007 8:06 PM

P.S.: The Unicorn is right: Medco rocks. They're responsive, fast and you can order online. They'll even contact your doctor for you.

Posted by: Jurgen Nation at June 21, 2007 8:08 PM

Sweetie, I have to take three highly proiced medications. I get these letters all of the time. Drives me nuts. I ignore them knowing that the 1000.00 I pay PER MONTH for this frigging coverage makes me less likely to have them screw with my life. They can literally shove it!

Posted by: Maribeth at June 21, 2007 8:25 PM

I will GENTLY point out... gently gently..
that it is only $25. that's it. Imagine most of the country that does not have health insurance and probably can't even afford the doctor's appointments to diagnose their problems. We all have our extravagances (HBO, lots of books, eating out, etc) I have a feeling that the full price of your medication is near to unbearably high. I have a feeling, as well, that as a well-compensated IT dude that, although your family is living mostly on one income, you're still doing okay on the money-thang.

I'm just saying...

Posted by: pagalina at June 21, 2007 10:36 PM

I agree with chantel that the whole system is really f-ed up.

I also take anti-depressants and just recently made a switch from one to another. Let me tell you, it was not super fun! Fortunately, this is the only medication I take and the only reason I ever go to the doctor. Thank God for good health so far!!

I feel for these poor people who are really sick and have to fight with their insurance company for treatment. Don't they have enough to worry about just being sick? Unfortunately, it's all about the benjamins, baby. These are publicly traded companies and don't answer to their customers. They answer to their stockholders.
I've been looking forward to seeing "Sicko". Doing that movie make Michael Moore decide to change his lifestyle and lose weight. Wow!

The other problem is that we have a lot of people in this country who just refuse to be proactive and take care of themselves. Some of these medical conditions can be avoided, like obesity. How many people get gastric bypasses every year? And because of this, our healthcare costs skyrocket. What about smokers? Do they think they're going to be the first one to avoid illnesses related to cigarettes? Don't get me started! I'll do my very best to stay as healthy as I can just to avoid aggravation of dealing with insurance companies!

Posted by: snakeepoo at June 21, 2007 10:59 PM

I'm really sorry you have to deal with this. After 13 years of excellent medical coverage in France, I currently have no health insurance. My doctor is very cool, and gives me samples of the medication I need. Otherwise I'd be paying about 100 bucks a month.

The system in the US is broken.

On another note, the letter in your post made me laugh!

Posted by: Alison at June 22, 2007 3:11 AM

Make sure you have your physician draft a letter to the bastards and explain that your drug is the one drug that cures you, and that if he/she wanted you to take the alternate drug, by God he/she would prescribe it. Sometimes that makes a difference. However, a $25 co-pay is the norm. I don't have a co-pay system, but with my mail in plan I'm paying $40/generic for a 90-day supply and $60+/brand/90-day supply.

Posted by: coolchick at June 22, 2007 6:37 AM

Bastards. In my favorite example from our own beloved insurance company, a claim for one of our twins was denied as a "duplicate." After they'd just processed 8 million other claims for each baby -- all manually, since they screwed up every single one. You'd think that would be memorable. Maybe.

Posted by: Julie at June 22, 2007 10:09 PM

Actually, I think alfredsmom had a really good idea. We all grouse about this kind of thing, but it would be really effective to get something like the Fox or NBC4 On Your Side guys involved. I think if as many of us spoke up about this as are having problems, something might actually get done about the healthcare system. Public embarrassment usually goes a lot further with moneymakers and politicians than common sense I've found. Just a thought.

That being said, I can also totally relate. Every time I have to get an insulin (INSULIN. These assholes have yet to understand that without it I'm circling the drain in a matter of hours) not only do I have to fight with the incompetent idiots at CVS about the dosage amount, I have to almost always call the insurance company myself to get them to release the prescription and get it paid for, even though my doctor writes the script for the correct daily dosage range every time.

My best story lately, though, is that when I had to be put on Prednisone last month, my insurance company actually called my doctor to scold her and tell her she couldn't give that to me because it would raise my numbers. She's a friend of mine and called to laugh as she told me where exactly she told that claims rep to put it. WTF is wrong with these people?

Posted by: Sassy at June 23, 2007 1:32 AM

I suffer from chronic depression along with fibromyalgia, etc. I get this from the insurance company ALL THE TIME. In fact, I choose to pay extra for the meds that I have found work for me, through long periods of trial and error. And for the folks that point out that the actual $$ is relatively small - it is the principle that an insurance weenie behind a desk is trying to make unqualified medical decisions on an individual he/she has no data on other than bills.

For the lady on Medicare whose husband is doing without meds: if you have not already, please check into programs with the manufacturer of the drugs your husband needs. They are out there, and you really can get help. My dad did, and it was a lifesaver.

Posted by: KathyK at June 23, 2007 1:50 PM

Has there ever been a trustworthy, non money hungry insurance company ever?

I hates them.

Posted by: Jenn at June 24, 2007 1:10 AM

I just got back from vacation and am catching up. I agree whole-heartedly. I'm on some major meds for depression myself (and yes, I have finally found something that works!). Of course, they run like $250 a month and of course some time in the future the insurance people are going to say hell no and that's a shame, because I'll be out more money, but I'll still be on something that works.

Posted by: Heather at June 26, 2007 5:45 PM

I'm a little late to the party, but please say you wrote a letter of complaint.

Posted by: anna at June 29, 2007 12:11 PM