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Totties Pretties on Etsy

Totties Pretties on Etsy
Tottie's Pretties are ribbon wrapped headbands adorned with flowers & gems or perfect boutique bows. Banding Girls Together to Find a Cure for Childhood Arthritis. Tottie's supports CARRA and the Arthritis Foundation.

Thursday, September 23, 2010

Insurance Woes

I hate insurance companies. Who's with me? Everyone right? *sigh* WHY do they have to make everything SO gosh darned difficult?? So a few weeks ago we get a letter saying that the kids health insurance has changed. We knew it was coming. No big deal right? Yuh. A couple days later I get a call from the pharmacy (that we LOVE to pieces!) saying they tried to run Jenna's refill on her Humira (they set it up for auto refill because they are THAT awesome!) but it won't go through. So I tell her about the change in insurance and that Larry had brought in the new info for some meds we had picked up the previous week. No problem right? Yuh. So she looks it up, gets the new info, runs it, DENIED. Say wha'?? Yeah....they denied it. GREAT. She says it's not uncommon, let me fax a form to her rheumatologist. They just need to fill it out and fax it to the new insurance company. Then you should be all set. Just normally takes a few days, a week tops. Oh thank you, thank you, thank you! So I'm stressing over it. Worrying that they will still deny it. Then it hit me. Can I control this? Nope. Not one bit. So I gave it to God knowing that He will do what is right and best. After a week we get the approval letter. YES! We go to get her prescription. She is already one week late now but I'm okay with it at this point. Larry comes out empty handed. HUH? The insurance company is requiring that a "specialty" pharmacy fill the prescription. A what?! Never heard of such a thing. So he calls Medco, this is what the ins. company tells him to do, to get a list of approved, local, "specialty" pharmacies. By this time he needs to leave for work. I tell him to just go and that we'll get it filled tomorrow. Figuring at this point what's one more day? So he heads out after sleeping a bit the next day. To ALL the listed pharmacies. NO ONE can fill it. It won't go through. All the pharmacists called the insurance company and got nowhere. REALLY?? So what NOW? So then we are told to try Acreddo Health. So Larry calls them, gives them all her info, and they say it shouldn't be a problem but they need a new prescription sent. They can't transfer an old one. *SIGH* By this time the doctors offices are closed. I'm also thinking, Yeah...shouldn't be a problem. Shouldn't have been a problem for the local places! So first thing this morning I call her rheumatologists office and speak with the nurse. She has NEVER heard of such a thing. NO KIDDING. She has heard of insurance denying a claim. Never heard of having approval and still not being able to fill it. RIGHT? So she says we'll give Accredo a go and hope it works. So she says she will fax over a new prescription. Larry calls a few hours later to see if they got it. They won't know for 24 hours. Seriously? C'mon! So now we wait until tomorrow morning and hope and pray that they have it and can run it through. In the meantime I had received a call from a friend whose daughter is a pharmacist. WHY didn't I think to call them yesterday?? Anyway, she puts her daughter on the phone to see if we can figure this out. She says that she has never heard of Humira needing to come from a "specialty" pharmacy. That is normally for specially mixed meds that aren't mass produced. She also said that there is an over ride in the system to go around these issues. Oye. So just now as I'm typing this I get a call from the nurse saying that Acreddo just sent her a fax saying they need Jenna's ID number. UGH! Larry gave them all that info yesterday! Seriously? Lord? WHAT is going on??? So the saga continues....stay tuned....