TBO.com - TBO is Tampa Bay Online

Drug Plan Leads To Anger, Pain

ADVERTISEMENT

The Tampa Tribune

Published: March 4, 2009

The pain began in my stomach about an hour after dinner and sat there like an exhausted runner taking a rest. It never moved, it never grew. It felt permanent and that felt scary.

And along with the pain came the rage, anger I had never felt before. I had both the anger and the pain because my insurance company was making it difficult to refill a prescription I had been taking regularly two times a day for years.

Suddenly I received an e-mail explaining that the prescription I had submitted for refill could not be processed without "prior authorization" by my physician. I called the drug plan to ask why and began a painful journey into chaos. They merely explained that this authorization was required before I could receive any more of my medication, never explaining why after years this had suddenly become necessary. They said the doctor could "phone it in" or submit a fax.

I called my doctor and his receptionist explained that the insurance company was doing this because the medicine was expensive and they wanted the doctor to prescribe something generic. I had tried a generic and it didn't work. She said that the doctor would not call in the authorization by phone because each time he did this it took half-an-hour of his time. He would, however, return a fax.

Things began to get complicated, so I began to get organized. I took out one o my white notebooks and began a medical incident log. I wrote down the time and date of the prescription refusal, of my phone call to the pharmacy, of my call to my doctor. I included the names of the people I had spoken with and what they had said.

I went to the doctor's office and requested another prescription that I could take to a local pharmacy. I got it and the pharmacy was also unable to fill it because there was a prescription pending with my insurance company (the one I had submitted for refill).

I called my drug plan to find out when the authorization would be faxed to my doctor. It took days of calling to confirm that the fax had been sent. Once the doctor received it, I was informed I needed to come in and sign it. I did that (second trip to his office), and they faxed it back to the drug plan. When I called to confirm their receipt of the authorization I was told it would take five to seven days for the fax to "be scanned into our system."

Meanwhile, I had run out of my medicine. I returned to the local pharmacy and pleaded for a few pills to carry me until I received the medicine. They sold me ten pills for $56, explaining that I could claim the deduction later from my insurance company.

So instead to taking two pills a day, I began to take one to try and make them last. And I began to have pain. And I began to boil at the injustice of the suffering. What if my life had depended on this medicine? Thankfully, it didn't. I was lucky. All that was dependent on this medication was relief of pain.

After agreeing to pay an extra $18 to have the medication overnighted, I finally got it. It had taken from Nov. 19 to Dec. 12 to get it. What should have taken three days took 23 days to arrive.

Don't get me wrong. I'm grateful to have health insurance and especially grateful that my insurance offers a drug plan. What horrifies me is the power insurance companies wield these days. I thought life and death belonged in the hands of God.

Reach Judy Kramer at JudyandOz@tampabay.rr.com.

Share this:

Loading Comments...

Email Print

ADVERTISEMENT