I want to meet the insurance geek...

Discussion in 'Fibromyalgia Main Forum' started by PAT, Feb 20, 2003.

  1. PAT

    PAT New Member

    Who in the heck do insurance companies think they are??? The gods of meds?
    I have been taking Ultram for 5 years now. I have tried every pain med out there,and this is the one that works the best for me.
    My insurance company recently changed hands, and when I went to get my Ultram refilled, I was told, too bad, so sad, the insurance gods said no. NO??? So, with one little two lettered word, I am off my Ultram- cold turkey.
    Thankfully, the company doesn't set up shop in my town, or I would have most likely been on the evening news.
    So, my new doc calls in Vicodin. I don't WANT Vicodin. Been there, done that.
    I have begged them to try a precert, and get my Ultram back.
    Meanwhile, my pain is at a sickening level, I am a Jekyl-Hyde with my family, and more angry than I've ever been in my life.
    Why can they do this?
    'They' also decided they won't pay for my son's Xopenex. He has Cystic Fibrosis, and uses inhalation treatments every day. All of his 4 years he has used Xopenex, but they say, NO, we will only pay for the original Albuterol.
    His pulmonologist is MAD. She is trying to change their minds.
    Isn't this insane????
    I would LOVE to meet in person the idiots who make these decisions. I keep thinking of the 'Erin Brockovich' movie and think I may just take up where she left off.
    Thank you for letting me vent.
    Patti G
  2. pam_d

    pam_d New Member

    Are you in the US? Every state, I believe, has an insurance commission-----we elect the commissioner that runs it. They are supposed to monitor insurance companies, and SHOULD want to know what their constituents feel are abuses by insurance companies. Go to your state's website, & find out how to lodge a complaint. Obviously, government wheels turn at a snail's pace, but at least you'd feel as if you are channeling your justified anger productively. I agree, the people making decisions don't have a clue!!

    Good luck & hope you find some relief for you & your son,
    Pam
    [This Message was Edited on 02/21/2003]
  3. PAT

    PAT New Member

    I needed a little redirection! I think I will do that once I calm down. I want to get more people talking about this, because I have learned today that it happens often.
    I feel sometimes that I shouldn't bother to complain, because one voice won't make much of a difference. However, I may just find a lot of others willing to help me get out there and say that this kind of treatment isn't acceptable.

    I think the insurance companies rule the world, and I would like to see them be forced to make a change.
  4. Mikie

    Mikie Moderator

    All managed-care plans have an Rx formulary. They are at least required to carry one drug in each catagory unless a drug is considered too new or experimental.

    Now, that doesn't mean they won't pay for it. Your doc needs to go to bat for you and explain to them that the drugs on their formulary do not work and that you need the other drug. You need to call customer service and find out how to file a grievance. You need to bug them and bug them and bug them, but do it nicely. The squeaky wheel really does get oiled in the world of insurance. If all fails, threaten to file a complaint with the State Insurance Commissioner's Office. If this doesn't strike fear in their hearts, go ahead and do it. BTW, don't deal with the poor young, newly-trained, low-paid customer service person who may or may not speak and understand the English language. Ask for the supervisor. I mean no disrespect to immigrant minorities with this post, but I do believe the ability to speak and understand English is essential for those working in the medical customer service area. Good luck.

    Love, Mikie