NIGHTMARE ON Rx INSURANCE STREET

Discussion in 'Fibromyalgia Main Forum' started by hartogold, Jun 13, 2006.

  1. hartogold

    hartogold New Member

    Hi my dear friends...

    There is no way that I would even begin to put this entire saga here, so I will attempt to enter the reader's digest version.I'm have been disabled for 4 years and live on SSDI (a fix income). I had worked all of my life and the last 20 years I worked I was insured by my employer.

    We live in the country. My doc is 60 miles round trip and my pain doc is about 200 miles round trip. If I need a refill triplicate rx from either between office visits it's not just trip to the store. It's a trek and the gas prices are killing us! All this just to pick up a piece of paper with some scribbles on it. But I'd rather be able to get rid of most of my pain and be a part of the world rather than watching it go by.

    I have been using 150mg Fentanyl pain patches for about 10 months with ms contin for breakthrough pain (which I have to chew). It has taken two doctors months of trial and error to find the right pain cocktail for me. You see, I have had stomach surgery which has affected my ability to digest medications like the normal person. I was so happy, to finally find the "magical elixor" for my pain.

    My doctor strongly reminded me that once I started on the patches, I would become addicted and when/if I don't need them anymore I would need to come off of them gradually. If I stop suddenly, I could go through the severe withdrawal...possibly fatal. I am very good about making sure my doc and I are on the same page.

    On the Friday afternoon, before Memorial day, I took my Rx for my patches in for a refill. When I stopped to pick them up I was told that my insurance, WELLCARE SIGNATURE PLAN didn't approve them!! They had been paying for 10 months! My doc nor I were notified of this so we could be prepared! And I had to get through a 3-day weekend of chomping at the bit to "fix" this. My patches run about $500 per month which is almost half of our income.

    For the next 2 weeks I probably spent over 30 hours of calls to my insurance, my doctors, and whoever else willing to listen to my panic and tears of fear and frustration. I journaled every call and every person I spoke to. When this first started I kept a kind, patient demeanor, but as each day went by I went from that to apathy and anger.

    I 29 phone calls. I spoke with 43 different reps, two managers, 6 pharmaseutical staff. Every time I was asked to hold was grating on my nerves. I was put on hold for a total of what seemed like a millenium at times. 5 of the times cut off with no return phone call. This meant going through the entire story to two or three different people each call. By the way, I've always been one of those very patient people who will let people walk all over me. Oh yeah, there system was down three times too.

    It took a over 10 days get them to fax the appropriate form for my doc to complete and when she faxed it back, they said they never received it!! I then asked her to please send whatever forms I needed to file a formal complaint against the company and I have yet to receive that. I also phoned Medi-care and they are filing a formal complaint on my behalf against them as well. They were wonderful about helping me find a new plan that would fit my needs and cover ALL of my meds. (Pacific Care Saver).

    Meanwhile my sanity was slowly running out of all my pores and the patches I had on suddenly turned into gold. I was going to try to stretch the two 100's as long as I could until this fiasco could be resolved. All I could think of was the horrors of withdrawal getting closer.

    I was feeling ok until last Thursday 6/8. The withdrawal symptoms started and the pain was returning. All my pain doc could do was prescribe a weeks worth of ms contin which took the edge off a bit. Cold sweats, nausia, vomiting, paranoia, crawling skin, etc. I don't even want to talk about the horrors of Sat and Sun. Rigor mortis started setting in and they had taken my oil can.

    On Monday morning June 12th, I called Wellcare AGAIN, to get and update and was told I was still denied the patches I needed so badly. I called two more times that day and after going through another 3 different reps was still being being denied or the jury was still out. The next rep said that it had been approved the previous Friday but neither my doc nor I was notified!! And my doc put the word "stat" when she submitted their completed form.


    The communication within this company was an atrocity! Hell, I did better casenoting in my little journal than they did their computers.

    Anyway, my hubby put my patches on last night and I'm getting back to norm with each minutes that passes.
    Sorry, I guess it did turn into a saga...but to me...it was a NIGHTMARE!!! Thanks for joining me in it!
    Hugs,
    Sandy
  2. sues1

    sues1 New Member

    I am so glad......that after all the insane calling and work you did on this.......that it worked out. Most would not have persisted as you did.

    Thanks....you have helped me to know if this ever happens to me to never give up.

    Blessings............Susan
  3. tonakay

    tonakay New Member

    What a total nightmare girl! I think I would try to slowly make me a litte 'emergency' stockpile of patches if possible. It's a shame there isn't some way around these insurance companies when it comes to medicine that can throw people into withdrawal.

    I'm glad it's finally settled for you, this time anyway!
    Hugz,
    Tona