Thursday, February 20, 2014

TeeJ: 1 - Insurance: 0!

Sort of... I can't believe that I've spent 3 weeks trying to get prior authorization for my Lupron prescription. I got the prescription on the 31st and I knew right away that I would need approval before it could be filled. I called Dr. K's office the same day to let them know that. I really didn't think it would be a problem. But...  It took a week for the office to file the prior authorization forms. Then, it was denied because the insurance company didn't think it was medically necessary. So I had to go back and deal with Dr. K's office because Dr. K is out of the country. Even with my constant calling, there was no movement on their part until DeeJ urged me to email Dr. K directly. Within 45 minutes, he not only responded, but told the Dr. covering his cases exactly what to state in the medical necessity letter. When I saw the phrase "severe Endometriosis" in the letter, I panicked and started reverting back to my old negative thoughts. Am I going through all of this for nothing? How is it so severe, and I not only cycle on my own, but I'm pretty regular, but I feel no pain or discomfort? And so on, and so forth. I also started questioning whether or not I should stay with Dr. K. I have nothing against him and I personally think he's great, but his staff clearly lacks efficiency. The last thing I need is to be mid-cycle and Dr. K becomes unavailable. I just get this feeling that everybody would just stand there and wait for him to return. But all of my thoughts and feelings didn't last very long. Yesterday, I received a call from my insurance company saying that my prescription was approved! It was like seeing the light at the end of the tunnel! Unfortunately, the woman who called didn't tell me that it approved for mail order prescriptions only. BOO!!!! Since I already submitted my prescription to my local CVS, they canceled the prescription and now I have to get a new one. Awesome. First thing this morning, I called Dr. K's office again and asked for a new script. About an hour later, I got a call from Nurse L. I really like Nurse L. She's really nice, and every time I see her, we're matching a piece of clothing. After I told her what happened, she said she'll take care of it and even get me the rest of my scripts for all of my meds for the next cycle so that we don't have to go through this again. I wish they would just let Nurse L. handle everything because all of the other nurses and staff I've spoken to, no one else thought of or suggested that. Ah well. So that's the good news. The bad news is that I was supposed to start taking my Lupron during the middle of my luteal phase. With CD1 coming tomorrow, that obviously isn't going to happen. So unless Dr. K says otherwise, it looks like I'm benched until my next luteal phase. That plus 4 weeks of Lupron puts me at the end of April.

2 comments:

  1. Ugh, so frustrating! I'm glad it eventually got sorted out, but I'm sorry that it might end up pushing you back even further, I would be so irritated, to say the least! But I am glad you were victorious against insurance in the end! :)

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  2. So sorry Tifany :-( It is really frustrating to deal with insurance; they are the WORST!!! But at least you have it and they are going to cover it which is great news. Can't wait to see you tomorrow!!

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