Dear Insurance Company
Posted By Kristabella on February 8, 2009
So this afternoon I finally decided to open the mail that had been piling up for the last couple of days weeks. Since all my bills are paid automatically through my checking account, there isn’t much to open besides the credit card statements, and I know the exact days those are paid each month.
Mostly it is junk, or copies of the bills that have been paid, CDs that were Christmas presents in January, etc. In this pile there were a lot of W-2s and tax information and a few envelopes from my stupid insurance company. I ignored them for the most part because I thought they were just sending me a reminder that my health insurance from the old job, as part of the severance, is about to expire at the end of February. (And the insurance at my new job takes over on March 1. How perfectly did that work out?) So I didn’t rush to open them because I’m well aware that my old insurance runs out February 28.
Well as is almost always the case when I let my mail pile up in-between several issues of US Weekly, there’s usually something relatively important that I miss. Like say, for example, a letter from the unemployment office telling you to call them because they didn’t realize you got a new job. Not that that has ever happened to me.
In this stack of mail, I had three separate things from CIGNA. They were all about my most recent prescription. My prescription for Nexium to cure the FIRE IN MY BELLY. Basically these letters, ALL THREE OF THEM, told me that “hey, we’re so not filling any more prescriptions for Nexium for you. That is a Step Three drug and you’re not allowed to use those drugs because they are expensive and cheaper drugs do the same thing. Like Prilosec. You should totally use Prilosec. Prilosec is awesome. Here is a coupon for Prilosec OTC. It’s totally available over the counter now, Prilosec is, and we are showing how much we love Prilosec and our need for you to use Prilosec, buy using it as many times as we can in this letter. Sincerely, Prilosec. I mean CIGNA.”
I’m so not even kidding.
I get why they are doing it. I mean, Nexium is expensive. Even with a prescription, it was quite a bit. But it was what my doctor prescribed. Because it HEALS the lining of the stomach, and since that is what she thinks I need, she did what I pay her to do, and FIX IT. It wasn’t like she was carrying around a “everybody needs The Purple Pill” sign and using a Nexium pen and had painted the waiting room the same purple of the pill. She’s not in the drug companies back pocket. (Well, she may be, but she doesn’t come off that way. I mean the purple candies she makes everyone try and eat were a little over the top.)
The thing that bothers me is that I go to the doctor once or twice a year, usually. The amount of money I pay for my insurance premium is probably more than the costs I incur by going to the doctor each year. I always get generics and I avoid the doctor like the plague. Insurance companies must love me.
Don’t get me wrong, I LOVE that I have insurance and that for a $20 co-pay, I can go to the doctor and get medicine and my issues resolved. That is not the issue. I know I am very fortunate and that many people out there are not as fortunate. Which is what Barack Obama is going to fix.
But my issue is that because this drug is “like every other acid reducer out there, like Prilosec OTC” the insurance company refuses to let me have it. And since my doctor prescribed it for 6 weeks, and my insurance would only fill it for 30 days, I am now stuck in insurance hell-hole right now while I try to get my refill. My refill for 12 pills. Twelve. And now I’ll probably have to go use Prilosec (but only the generic is allowed before you’re allowed to try any other acid reducers.) And then if that doesn’t work, I get to try other acid reducers to see if they work before I get to go back to Nexium again, which DOES work, thankyouverymuch.
I can call my doctor and she can call the insurance company and try to tell them why she prescribed this and that it is only, right now, for six weeks, and that she had good cause to prescribe this particular medicine for me. Which, I will do, but again, all this is a bunch of bullshit to go through for trained professionals. My doctor is not an idiot. I trust her. Therefore, CIGNA, since she’s part of your network, maybe you should too.
Meanwhile, I’ll just sit here and stew in my own stomach juices. Thanks.
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This is why I hate insurance companies. They don’t trust anyone but themselves. And I seriously doubt that the desk monkey who decided that you didn’t need Nexium has ever met you, and thus knows your own individual needs. You might try explaining to your doctor what the situation is, and asking if she has extra samples of Nexium around. Even if she only gives you a weeks worth, and you fill a weeks worth out of your own pocket, it should save money and keep you from being in pain while you jump through stupid insurance company hoops.
tutugirl1345s last blog post..Oh, Hai…
Have your doctor call the insurance company. It’s a pain in the butt and aggravating, but if Nexium is what your doctor wants you to take, Nexium is what you should be taking.
I hate insurance companies. Mine recently decided that I wasn’t allowed to refill my birth control at the pharmacy anymore and that I’ll have to order it online and have it sent to me. BUT THEY NEGLECTED TO TELL ME THIS. I didn’t find out until a Friday afternoon, when I went to the pharmacy for a refill. And, of course, the mail order prescription did not arrive on time, which messed up my entire cycle for weeks. Grrrr…
Jen on the Edges last blog post..The REAL story of the new house
I have had to call the insurance company pretty much every week since the baby was born. WHAT A PAIN! I hope your doctor can convince the insurance company you need the medicine you actually need.
-R-s last blog post..No Time Even For Funny Captions
And that right there is why I hate insurance companies.
Dutchess of Kickballs last blog post..Love Letter
Unfortunately, Nexium won’t be covered under the Obama plan either. As you all mentioned, read the fine print. My brother-in-law lived in Italy–the land of national health care. He needed a costly drug. You know how that was handled? The government did not permit the drug for sale–just wasn’t available. That’s how they keep costs down–just reduce the number of services available. Everyone really needs to read the fine print….it will scare you.
Oh dear… I used to work for an insurance company and almost mentioned this whole step-therapy thing to you when you said you were going to the dr. for that there belly fire… though the companies differ on some things this is a pretty common defense against folks who ask for certain pills just because they liked the cartoon on the commercial. I’m sorry I didn’t mention it before so you’d at least have a head’s up.
tmcs last blog post..Sunday Stealing: more random sh*t about me you probably already know
I will go to great lengths to avoid dealing with insurance companies and their bullshit, but this is a battle you should definitely fight. You pay a premium ALL YEAR LONG and they won’t give you 6 weeks of a prescribed medication? Something is wrong here.
nancypearlwannabes last blog post..Testing… Testing…
This is why you need to move to Canada – the Insurance companies just pay for what your doctor prescribes, no questions asked.
Seriously.
Angellas last blog post..Grace In Small Things: Cinq
GAH. Oh, the fiery hatred for the state of US health insurance. Like you, I am so grateful just to be insured right now, but what happened to the pretense that these guys were in business to, I dunno, take care of our health?
Don’t get me started on the alternatively crazy and/or confusing letters these companies send, either. I realize this coming from an attorney – hello, irony! – is a bit much, but could they make it any more complicated?
Rant aside, glad the purple pills seem to be giving you some relief.
Legallyblondemels last blog post..The Grace Experiment, Part 3
Seeing envelopes from my insurance company always puts me in a bad mood.
christinas last blog post..My newest addiction
THIS is what terrifies me about moving to the states. i know NOTHING about insurance. when i go to have my prescriptions filled, i don’t pay anything. it’s LOVELY.
alis last blog post..bubble girl
OK, calm down. Same exact thing happened to me when I tried to fill the prescription for the Prevacid. And that’s even more expensive than the Nexium.
I had to have the doctor call the insurance company, it took a day, and it was all done. And I have refills for it and they never ask questions now. I don’t know what will happen the next time, but at least I understand, it’s just procedural.
They never hassle me over stuff I need to take RIGHT NOW OR I WILL DIE. It’s the other stuff that makes it possible to eat, breathe and crap that they tend to deny me.
So call the doctor. Get ‘er done.
Candys last blog post..In Which I Declare “Bullets! Now, Improved!”
I hate insurance issues. When we had Quinn, my husband was denied leave from work, yeah, go figure….and we never received our bill to pay our own insurance premiums for the three weeks for my hospitialization and Quinn’s NICU stay. The fight we went over and over with not only the insurance company but the union was legendary in his former company’s circle.
I think that insurance companies operate on the hope that you won’t even friggin bother.
Candy is right, your doctor will get er done. So go call!!!!
And I know this isn’t a house blog, but how bout an update???
Sheris last blog post..Facebook Addiction and Being Alone
This exact same scenario happened to me with Cigna, but not Nexium. Some other acid reducer. Luckily, Prilosec is worknig for me. BUT STILL, I FEEL YOUR RAGE.
Irritating isn’t it? The insurance companies are generally fine after an appeal. At least you have a good Doctor.
Saras last blog post..Twins escape death penalty because of their identical looks
Clearly the people managing your insurance claims all have MDs and know what’s best for you, even more than your actual doctor that has seen you in person. Because they’re psychic. And cheap.
thecoconutdiariess last blog post..Pigskin Virgin
Obviously, you know my feelings on insurance companies. They can kiss the bottom of my left foot.
They’re probably the same people that tell you to treat a bullet-wound with a bandage… (not a Band-Aid, mind you, because that would be a brand-name treatment, and they only accept generics).
I hate it when some desk jockey at my insurance company thinks they know more than my Doctor does.
Bastards.
Liz J in Central Illinoiss last blog post..I Love This
I used to sell drugs and some of the ones I sold were very expensive. I also worked for a TPA insurance company in a past life. I’m glad to see a person hitting the “no can do” button with less than a high school diploma gets to tell your Doctor, they are full of shit and they don’t know what they are doing.
A well written letter along w/that call from your doctor should get the ball rolling. I also found that copying a lawyer friend worked even better!
Don’t even get me started on healthcare costs and insurance reform. I can rant for days! I see it from a different perspective and it’s even shittier than yours!
Sarahs last blog post..Just Plain Crazy
What’s the cost of paying for it outright?
dude, that would piss me RIGHT THE HELL off. doctors ALWAYS prescribe the generic if they think it’s all you need. the doctor says you need it, MAYBE THERE’S A REASON. grraaaarrgggh @insurance companies.
Alices last blog post..running! dates! meat!
Can you think of a way to get your doctor to prescribe wine?
that would be good.
witchypoos last blog post..Explaining the Family Tree to Hidden Treasure
This is why we ALL need to move to Canada. Our healthcare system is seriously so ridiculous it makes me crazy. Generic is NOT THE SAME. Which is why it’s generic. And while it totally works, sometimes, it totally doesn’t work other times. Why do insurance companies get to play doctor?
Kerri Annes last blog post..Because My Brain Is Exhausted: Before And After Photos. Sort Of.
Sounds about par for the course. What a load of bull from CIGNA! Hey, is this the same CIGNA that recently got bailed out, like last fall?
Coast Rats last blog post..IT’S MARDI GRAS TIME AGAIN ON THE MISSISSIPPI GULF COAST!
That is such bull shit, seriously. You were prescribed that because you need it. The DOCTOR prescribed it, how dare the insurance company tell you what you need. They aren’t doctors (well some may be) and they didn’t see you. Tell them to get bent, and have you doctor call them. And be glad we AREN’T in Canada, in Canada you would be waiting at least six months to see a Dr. And who knows, by then your stomach may have just dissolved away.
I hate insurance companies. After giving birth to Ella, I was on the phone for TWELVE HOURS (in total; not at once) dealing with insane crap, like the anesthesiologist who screwed up a bill, resulting in me being told I personally owed him $3,086 for my epidural (which, totally worth it, but SO NOT THE POINT). I think a lot of times they just throw shit at you (cheaper pills, higher bills…look at me rap!) and see what sticks.
metalias last blog post..Fake Spring Week: I’m not making it up.
I went through something similar with my insurance a few years ago. I was like you and tried to use my insurance as little as possible but now I no longer care and go to the doctor whenever I feel slightly sick. I mean, I’m not the crazy lady at the doc every day, but things like my allergies which I used to treat with OTC, are now treated and tested by an allergist. I have a dermatologist and I know exactly how Urgent Care works. Screw you Blue Shield, pay for my health!
I went through exactly this but with my allergy meds. The irony is now that I’m approved for every medication out there (which took me six months to accomplish), my company has switched my insurance to a subsidized spending account plan, on which I decide what I want to buy and I can no longer be denied any medications. Oh, and even funnier? I’m now controlling my symptoms using saline nasal rinses instead of drugs. Yep, basically free saltwater. Sigh.
Hollylynnes last blog post..Its amazing all the great things I can force into the category of "Wedding Expense"
Do not take this….do not take this….do not take this….get your dr to write that note and don’t let up. Yes, you are right, you are fortunate to have insurance when many folks do not, but there are tons and tons of other drugs out there that cost way more. Zegrid works 100 times better than Nexium, but good glory, my co-pay went up to $60 for that…er.no thanks, gimme my purple pill back
Jerri Anns last blog post..Jen Lancaster – I was ready to pass out
i had to go through something similar for allergy medicine even though the preferred DID NOT WORK FOR ME! the doctor documenting it and telling the insurance made it work out. healthcare is a tricky tricky beast. i am with you–grateful to have it, but boy it would be nice if it wasn’t so devilish feeling.
micheles last blog post..GO STEELERS!