So I've been having some medical fun recently. My pharmacy insurance refuses to cover many medications they consider "routine" unless they are ordered from the insurance directly. But there's no convenient way to find that out until after filling it the first time at the local pharmacy, which they will cover. Its not based on how often you take it, its based on their list of what they consider routine. So recently I started a "routine" medication. Instead of telling me that directly they sent me a letter advising me my medication required preapproval or they'd charge me full price for the medication I had already filled with preapproval already obtained. I called my doctor repetitively asking them to get with my insurance to give another post approval, but they didn't call me back with anything useful, basically said we don't know what they're talking about either. Finally I called the insurance and they said oh we're sorry, when we send preapproval required letters what we really mean is buy from us or else. I asked if they could manage the transition to buying from them, they said no. So I called my doctor and asked him to send in a prescription to the insurance. He didn't do it. Later on trying to check if he had, I was logging into the insurance website and lo and behold, there was a button for initiate this order on our side. So I did.
But in the meantime with all these delays I ran out of medication and it was labeled on a big red sticker DON'T SKIP DOSES. So I called the pharmacy to see exactly what the "or else" of buying the medicine locally actually was. It was no coverage, but they suggested the insurance might make an exception. The insurance claimed not only under no circumstance would they cover me locally, but tried to tell me the local pharmacy wasn't even allowed to sell me a partial month supply without me getting doctors permission first. Called the pharmacy back, and they said no, they were happy to sell me the drug for $10 a pill for any amount I chose under 30 days. But, the pharmacist also said all I really needed to do was tide myself over with an over the counter substitute in the meantime and I'd be fine.
I really hate feeling like I'm fighting every step of the way just to get my medications. My doctor did contribute to the problem, but every single time I've interacted with the pharmacy insurance they've told me something that wasn't right.
So, getting back to my life, today I finally managed to get in the surgery follow up visit I had to skip when my insurance was canceled. I think I've freaked out the doctor. As I told him of every symptom aside from bleeding had continued he asked me if my insurance would cover this sort of thing. I asked him what he meant. You know its time to worry when he answers "I mean they wouldn't cover me sending you to the mayo clinic."
He clarified he might not have to do that, but he very well might like to. So I'm scheduled for another surgical operation where they just look around with a camera to see what in the world is going on. Then we go from there.... wherever that might be but apparently not to the mayo clinic because my insurance won't cover it.
3 months ago