Friday, May 29, 2009

The Perfect Storm

Most of you know I really TRY to see upbeat side of things, and although I get down, I don't stay there long. This recent episode has put all of that to the test and then some.

Yesterday I went to the pain management doctor. He changed my dose in an attempt to get things back under control after all I have been through. This in itself it upsetting, because before the insurance company messed things up, when I was on medication and stable, I was taking a dose that is half of what I am taking now. So thanks to all my body has been put through these past 4 months, I am on double the medication I was.

My doctor is an Orthodox Jew. I mention this because it has bearing on the rest of the story. I saw him yesterday afternoon, which is unusual for me, I usually see him early on Fridays, but because last night and today are both Jewish holidays he wasn't going to be working. He wrote my script and I headed straight to the pharmacy with it. I've learned my lesson well with this because if there is a problem and I wait to get it filled, they can't reach the doctor.

I arrived at the pharmacy to find their computer system down and them unable to fill prescriptions because of it. For those of you who are lucky enough to not need pain medication I can hear you now, "why didn't you just have it filled elsewhere?". Besides the fact that I truly believe that it is safer to fill everything at one place so they have an accurate record of all the medications I am on to check for interactions, etc. . . there is also the issue of taking a narcotic pain medicine. If you start filling prescriptions at different pharmacies, it raises a red flag with the government and your insurance company. They see it as "drug shopping", which is evidently something that addicts do in an attempt to get more of the medicine than they are supposed to have. In any case, I left the prescription with my pharmacist who promised he would fill it that night or first thing this morning, depending on when the computers came back up. In the meantime, he gave me 3 pills to get by until it was done.

This morning when I went to call to see if it was ready for pick up, I found a voice message in my inbox from the pharmacist. My insurance company was refusing to fill the prescription on the basis of number of pills prescribed in a 23 days period and (you can't make this stuff up folks!) they also had approved my medication in the brand form at the old dose, so I am now informed that my doctor will have to go through the WHOLE APPEALS PROCESS again for the new dose!

The reason I mentioned about my doctor being Jewish is that normally I could reach him and we could talk about what I might be able to do as an option, but as it is a Holy Day for him, I cannot reach him until Monday. This left mom and I trying to figure out what the best choice was, which ended up being buying the prescription outright for over $1200 on mom's credit card (this is a 30 day supply mind you!!). The other kicker to this is that the $1200 won't even count towards my "donut hole" because they haven't approved this medication now so as far as the insurance company is concerned it doesn't exist! That means I am still paying for 100% of ALL my medications while I am in the donut hole, not just my pain medicine.

I will have to contact the doctor first thing on Monday and get him working on the appeal, which I am sure will put a strain on relationship as it was an arduous task to go through once and neither of us will be happy to do it again.

In the meantime, I am where I always am, stuck in the middle with little or no control over any of the situation. I was reading Laurie Edwards blog post from A Chronic Dose the other day on illness and PTSD and thinking of how this situation makes me feel like I did two years ago when mom and I were forced to move back up to NY due to health problems and find a pain management doctor for me. We went through so much and it was so upsetting, and now it feels like that all over again. All the fear, the uncertainty, the frustration come back in waves. Even though I remind myself that it worked out then, it still scares me and makes me feel like I did back then.

I wonder how many of us go through this during really bad flares, etc. . . Right now my normally hopeful nature is being beaten down by the stress and fear, and I am more afraid than I have been in years. I also know my body and emotions are off kilter from all the medication changes. I just wish things didn't have to be so hard, and frankly at the moment I wish I had a partner or someone whom I could trust to handle all of it so I could just concentrate on getting well and not fighting the system day after day.


Shauna said...

Oh Maureen,

What a shame you had to go through all of that. The question is: are you covered with that med during this very odd back and forth??

I am getting so sad hearing about case after case of uncovered meds. And YOU are the one who commented once and told me about what "the donut hole" was. It shouldn't even exist.

I hope that your flares subside...and I agree about the friends, if we have them, let's keep them and let bygones be bygones, if they know what we are feeling, that pain; as so many do is a treasure that we must preserve. To be there when the other falls...even just a comment or email makes me feel better sometimes.

The days that the prescription has to be picked up and it is terrible...and like's just me to deal with these things. You know it is better to take care of all that ourselves anyway. Easier, we know the docs, the stores, the pharmacies. I agree staying at one but I still pay cash so I have to shop around. But it doesn't take too long to find THE lowest prices around here!!

Well, Gentle hugs, and I am sending positive thoughts your way.

ConnieFoggles said...

Aack! Here's some really big, comfy, loving hugs for you (((HUGS))) because I want to give them to you and because this is not what you deserve. I do believe in PTSD when it comes to chronic illness. I know it's not good timing now, but having a therapist to talk to about all of this can really help you. Or, if you feel comfortable with a minister, etc. Someone who is a professional and will let you get it out and knows how to advise you.

Kelli said...

Sorry you are going through the appeals process all over again. You bring up a valid point about getting all scripts filled at the same pharmacy. I am a firm believer in that too. I hope Monday goes smoothy for you.

Laurie said...

Gaahhh! I am sorry to hear how complicated, confounding, and frustrating things are right now! Certainly not what you need to deal with, and I really hope things start to turn around soon.

Thanks so much for commenting on/linking to the PTSD post, btw--I always appreciate your insights!

Laurie said...

Okay not sure if my first pass at this went through, but so sorry to hear things are so difficult and frustrating right now! Not what you need at all.

And thanks for commenting on and linking to the PTSD post--I always appreciate your insight!

Michelle from Houston said...

I have some of the same issues... do you have any suggestions about feeling better??? I've taken everything it seems, but NOTHING helps. Do you receive disability?
Is this something we just have to tolerate 4/ever bc I don't think I can... UGHHH!!! And... I teach 5th graders!
Michelle, 34 w/ hus. and active 11 year-old-son
No, the heat doesn't help (lol)

Debra said...


I was stopping by to check on you and I read your latest post. I am so sorry that you had to go through this ridiculousness! I do hope that you were able to get everything squared away.

You are so right when you describe your frustration with these illnesses. I don't know if I mentioned to you that one of my "lines of defense" is to see a pain therapist once a week. I have been seeing her for several years and she is a Godsend. Maybe there is someone in your area that you could start seeing. It really helps to have someone who understands chronic illness to talk to.

I pray that you are feeling better. Hang in there!

Big gentle hugs,

One Mom said...

It's been a while since you've posted so I'm just sending you love and prayers for strength and healing. I know it's not easy but don't give up.