Insurance Nightmare

Other people have ridiculous insurance nightmares, but I had never experienced an insurance company telling me that needed medicine prescribed by a specialist was not covered. After several calls to the doctor, numerous trips and discussions with the pharmacy and several cash buys, 5 pills at a time at $5.50 a pill, we received a four page document from our insurance company telling us how they knew better than our doctor what medicine Bob should be on to prevent further arterial blockage and therefore extend his life.

I was appalled.

The cardiologist, who specializes in heart disease and who looked at the amount of plaque in Bob’s heart prescribed a particular medicine and now the insurance company, who has not looked at Bob’s arteries, feels that a different medicine should be tried first. If it fails, then the other medicine can be tried. But we don't have a prescription for another medicine.

And, if it fails . . . how much do we risk on this? If it fails will Bob have another blockage? If it fails, will he have a heart attack? If it fails, will . . . . well, let’s not go there! We decided that our plan of attack would be to get the doctor to write a scathing letter to the insurance company and try to help them understand why this medicine is critical for Bob’s wellness.

Today, a different solution was found. The cardiologist chose a medicine that will accomplish the same objective and is on the approved list for the insurance company. Now, why didn’t he do that 14 days ago, when we first called him and told his office that we were being denied coverage? We spent over $80 in pills, because we didn’t have a prescription for an approved drug. I don’t really like this new world that we have entered.

What have I learned?

I guess I have learned to call the doctor's office everyday instead of every few days.
I know better what question to ask: Is there an equivalent drug that is covered by my insurance?

I am also thankful that we could afford to buy the drug prescribed for Bob while all this was sorted out.