I think, by now, everyone I know has experienced some sort of frustration or irritation with health insurance companies. I swear, they are more of a hindrance in obtaining proper health care than they are a help most times! Sadly, I think many people get so confused with all the paperwork or phone calls they have to muddle through to get things they might need, that they give up!
Recently, I have had a most frustrating experience and I am told that it is quite a common occurrence. This galls me.
Over a month ago I obtained a prescription for medication that my son NEEDS; not WANTS, but actually NEEDS! The pharmacy tech said there was a "problem" so she couldn't dispense the full amount, but she would give me 7 days worth. She said I should contact my doctor.
I called the doctor, somewhat stressed, but I was assured this would be fine. Within twenty four hours I was told I could return, pick up a new prescription for the same meds, and it would be filled because the office had been in contact with Blue Cross/Blue Shield and were told the prescription would now be covered.
I did all of that AND when I went to get the meds, I was told they were NOT covered. Several phone calls later and I was told my pre-authorization was approved in error and the doctor would need to prescribe a different medicine. I was LIVID because the meds my son was on were WORKING BEAUTIFULLY!
The nurse practitioner explained this happens more often than not and it's sad, but we just have to "work the system" as best we can. I was infuriated that someone who has NEVER laid eyes on my child and doesn't know ANYTHING about him could exert such control in his life!
Twenty four hours later I returned to the pharmacy armed with a new prescription. New meds. Now, we would endure another "adjustment period" and pray the meds worked. A week later, my frustration was almost at full throttle because the meds were NOT working like the first ones.
Again, I head to the pharmacy with a NEW prescription and mentally prepare myself for another "adjustment period". We start the meds and within days it's apparent there is a problem. These meds aren't it either. Even my child, an 8 year old, KNOWS the meds aren't working and he's confused as to why we can't have the first prescription he was on.
I now want to scream and shake someone until they make it right! My son is suffering and being used as a guinea pig! HOW can this be right??? HOW is this ok???
Do you know what this ALL boils down to?? It comes down to money. Not even A LOT of money, but it comes down to that. Blue Cross/Blue Shield does NOT want to pay for the medication that WORKS for my child because it costs slightly more than the others. They want me to "try" him on several different medications to see if they work and then they will re-evaluate his case and see if they would POSSIBLY be willing to pay for the medication that works! DISGUSTING!
I'm sickened by their blatant disregard for the health and well being of the people they are supposed to serve. I am NOT asking for a medication that is "not medically necessary". I am NOT demanding name brands; generics are fine! This is NOT an optional medication! It is something my child NEEDS and the insurance company seems to feel they know better than his own doctor and decided to DENY his medication!
Now, we are in the process of petitioning Blue Cross/Blue Shield AGAIN to have them give my son what he truly needs; what he DESERVES! We may win this time, the nurse says, because we have tried other meds, but at what expense? My son's health and well being has been and continues to be compromised by nameless, faceless, executives who sit high up in their posh office buildings and hand down decisions that are, quite frankly, ridiculous and unfair.
It's sad that a few extra dollars takes precedence over the quality of life of an innocent child. I wonder, if it were a child of one of these decision makers, would things be different? Would the medications be approved with NO issue? I'm absolutely sure the approvals would flow forth then.
Health care in our country has taken a backseat to many things and it's appalling. I get that it's a business, but it's still a business that provides a service; a much needed service and they are failing miserably.