The Music of the Plight

   

Now sit back and I’ll tell you me tale of woe.  I feel like there should be a sad harmonica playing.  Imagine sad, slow harmonica music.  Ooh, and a banjo.  Wistful banjo. 

Back in June, I wrote about the letter I received from my insurance company, apprising me of the exciting new program designed to fuck with my medication because they didn’t feel like paying for it anymore.  You can imagine how relieved I was on Monday when customer service said that my doctor could send a prior authorization waiver, which would allow me to bypass the step therapy program.  Add happy fiddle, Con brio.  I called my doctor’s office, gave them the information, and rested in the knowledge that everything would be just fine.  

Suspenseful fiddle only, pianissimo
Fast forward to August.  I called the mail order prescription service to refill my Lyrica.  It was then that I found out from a sympathetic and apologetic customer service rep that my doctor had sent the prior authorization, but the prior authorization department had trashed the prior authorization because I didn’t need prior authorization for Lyrica in June.  Through tears and incredulity of the idiocy of epic proportions I was dealing with, I confirmed, and actually had the prior authorization supervisor say to me that:

A) Insurance sent me the notification of the step therapy program, set to begin July 1st, before July 1st so that I would have an opportunity to get things in order with my doctor.

B) I did everything I was supposed to do with regard to getting my medication ducks in a row and my doctor did send a prior authorization waiver.

C) The prior authorization department did receive the prior authorization request.  It was logged as having been received.  

Suspenseful fiddle, mezzo forte

D) The prior authorization department said to themselves, “She doesn’t need a prior authorization for Lyrica,” and trashed the request.  They were not aware of the forthcoming step therapy program because they are not informed of policy changes until the day the policy changes.

Angry fiddle, forte

E) Even though they have it noted that the request was received, and that it was their fault that it was gone, I still needed to have my doctor send another request.


Return to harmonica and banjo, piano

Fortunately my doctor’s office hooked me up with samples while I waited for this load of shit to be flushed.  The first request from my doctor was denied.  They asked what other medications I was on or had tried, (because, I assume, that wasn’t on the first request.)  The doctor’s office said they would send another request.  If this one was denied, then I could appeal with insurance.  Until then, I would wait to hear back from the doctor’s office.  

As of yesterday, I hadn’t heard anything, so I called insurance.  They hadn’t received another prior authorization request.  Sigh.  The receptionist at the doctor’s office said that the only thing they had in the system was sending the request back in June and that, if insurance had denied the request, they would have sent something in writing.  I must have explained that insurance trashed the June request, the doctor’s office had called me, told me the new request was denied, and that they would send another one no less than three times, all while she kept tryng to interject with reasons why I was wrong, before she finally got it and/or didn’t feel like arguing with me anymore.  I listed the pertinent medications that have failed to moderate my fibro symptoms, repeating another several times that, no, the mail order pharmacy only handles one of those prescriptions.  She retorted that since the mail order pharmacy doesn’t handle two of them, it was likely that they would deny the request again.   

 

Blues harmonica, adagio, mezzo forte

I felt defeated and resigned to my fate.  Life was hard enough as it was, but it was about to become a living hell, as far as I was concerned.  Mike maintained cautious optimism, as is in his nature, but I just couldn’t see this ending well.  It’s not like the process thus far had given us evidence to the contrary.  But then, (swelling choir of angels) miracle of miracles, I got the call.  REQUEST. APPROVED!

Cue gospel choir singing “Oh Happy Day!”

FINALLY!  After phone calls and despair and people being fucking clown shoes, I had succeeded!  I was finally going to get the medication I needed!  Now, apparently I needed to wait a day or two to call in the refill, but that wasn’t a huge deal.  After lunch today, I made the call.  Customer service informed me that they couldn’t refill the prescription. While there were two refills left, the prescription had expired on August 27th.  So they need a new prescription mailed which, fortunately, I have.  

Hopefully I won’t get fucked over anymore.  My ass is super sore.  


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