Good News on My Endoscopy, but...

Discussion in 'Fibromyalgia Main Forum' started by dhcpolwnk, Sep 17, 2003.

  1. dhcpolwnk

    dhcpolwnk New Member

    Well, I had my endoscopy yesterday, and as many of you had assured me, there were no real problems. I didn't even realize the procedure had been done. I remember seeing the doctor hook up the IV line to the connector (shunt?) in my hand and start the drip. I noticed my vision going a little crazy, and the next thing I knew, I opened my eyes and found myself looking at a different scene (the bed had been moved) and again finding that things seemed to be jumping around in my field of vision. I thought I hadn't gone under yet! I never felt the doctor use the plastic "frame" to keep my mouth open, and I never felt the endoscope go down my throat. Moreover, my throat was no more irritated after the procedure than before. Of course, since I've had a sore throat for more than a year (maybe more than 2 years), that isn't saying much.

    The doctor said the tissue looked fine, and he didn't take any for biopsy. But he must agree with the GERD diagnosis I got years ago, since he gave me an article on GERD. He said that the Prilosec I take (20 mg 2/day) is the treatment of choice, and that I needed to see an ENT about the sore throat. (That appointment is scheduled for Sept. 22.)

    However, today I discovered that Kaiser (my HMO) says I have nearly reached the $2000 cap on my Rx coverage--in the four and a half months I've had it! When my husband and I checked further, it turned out they were applying the difference between my $30 copayment and what *they* say is the cost of Prilosec toward the cap. That alone amounted to about $1300! And Prilosec has just gone OTC. We found a pharmacy where we could get 210 capsules for $125. Kaiser wanted to charge us $668 for 200 capsules!

    And Prilosec isn't the only drug they pulled a fast one on. I also take Flonase, which they recently dropped from their formulary. When I was paying out-of-pocket for it, they charged me around $30 for a 30-day supply, or about $90 for a 3-month supply. Today, the Kaiser pharmacist told us the it would cost us more than $400!

    To say the least, I'm furious, and I want to fight them. But I'm so tired of fighting. I was so upset about this I've been talking/yelling about it, and that's making my throat hurt worse than ever.

    I'm also challenging Kaiser (and Medicare) on denying coverage for repairing my scooter (the wheelchair-substitute kind, not the recreational kind). I thought that after 24 months on disability benefits, getting into Kaiser's Medicare + Choice plan would finally give me decent DME and Rx coverage.


    Sorry for venting, but I'm really seething!

    --Laura R.M.
  2. sumbuni

    sumbuni New Member

    Sometimes we think life really is too much, but you know, it's some of the people in it that make it so bad, and not life itself.

    I hope you are feeling better soon. And I pray that those who make life worse for those who struggle will get a little insight into what it feels like to be treated the way they treat others.

    God Bless!


    PS It's ok to vent...we all do, and isnt it great to have a place to go that you can let it all fly????