It’s sad that I feel the urge to celebrate (specifically by jumping up and down several times) when I receive a check in the mail from my insurance company — for a refund covering a medication that should have been covered under my insurance in the first place! Anyway, welcome to the Big Bad World of health insurance companies.
It all started back in January, when my doctor decided that I needed to increase my dosage of thyroid medication at my compounding pharmacy. It was only an increase in one pill per day (when I was already at 3), but the insurance company had a field day with it. They denied coverage because of a variety of excuses — including calling it a “vacation dosage” instead of acknowledging that my doctor had increased the prescription count; saying that they only covered a certain quantity of the T3 powder for the compounding pharmacy for a monthly refill. You name it, they gave the excuse and denied coverage…for 6 months!
I continued to file claims every month since January. There was no way I was paying $120 per month for the rest of my life on this one medication. This is why I have a health insurance company! Because they should be covering my medications that I cannot afford.
It’s always the same story with health insurance companies. They make us (the already-exhausted-from-various-ailments-and-medications people) have to file paperwork for prior authorization for the medications that actually work (a.k.a. the expensive ones or Brand name). And most likely there is some issue with the claim through the pharmacy, so the medication is either denied or put on hold (probably the worst thing you could do to someone in PAIN). So the patient (or victim, I should say) usually just pays out-of-pocket for the medication because they can’t stand to wait for all of this paperwork to process. And then they are forced to file more paperwork and claim forms individually just to get coverage on the medication and their refund to go on with the rest of their life. Talk about a painful process (pun intended).
But this week I am celebrating — finally — the fact that the claims process actually worked for me. For once, the system that I so greatly despise is finally on team Lauren! Now to see if they will continue the coverage or make me file an individual claim form every month for the rest of my life…fingers (and toes) crossed for me!