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Old 02-20-2008, 07:42 PM   #1
april1848
Senior Veteran
(female)
 
Join Date: Oct 2007
Location: Ohio
Posts: 940
Insurance Problems Figured Out

Hello, friends.

I posted a little while back about problems with my insurance. They had said that my benefits had changed, etc. Since then the company that sends my injections was letting me make payments on my high deductible, so I was able to get my meds on time.

Well, this morning they called me and said my insurance company told them that for now on I'd have to prepay $3,000.00 per month and then submit a claim for reimbursement. There is no way I can afford to do that. The drug company told me they couldn't ship my next doses until I paid it. The guy I talk to there is very nice and knew this was some mistake.

I called the insurance company. They told me, again, that my benefits had changed and suggested I speak to my HR department. I told them I am the HR dept and my benefits did not change. So I called the people that run our Group benefits. By this time I was crying and extremely angry! My boss was in the background saying "tell them if they don't fix it they're gonna hear from me" and other things. They said they'd investigate.

Six hours of faxes and phone calls later, I was finally told by the guy at the pharmacy that there was a glitch in my insurance company's computer system and it would be fixed in April! Until then, my insurance company would send me the reimbursement checks, and I would have to forward them to the pharmacy. That was all it was, and I'll get my shipment tomorrow.

Needless to say I am very relieved and happy that this mess was over, but it made me angry. I am lucky that I'm the HR person and knew who to call and what to believe. I'm lucky I have a background in insurance and I understand it. What if I didn't? How many other patients have been having the same problem because of a computer glitch that wasn't caught until today? I sent letters to state authorities regarding my insurance company a month ago and haven't had responses yet from either.

My biggest stressor right now, by far, is insurance coverage and how long I'll be able to work full time. In the past few weeks, this stuff has honestly made me sick to my stomach. I know I'm not the only person going thru this, and many people have it way worse than I do. I just got angry about the unfairness of it all! Not just angry, but sad.

Thankfully I am feeling pretty well except for pain in certain places and severe fatigue. I'm grateful I was well enough to handle this stuff today, and that my boss didn't mind that I was on the phone for so long. My boss who can be atrocius was great today, angry along with me, and later relieved along with me. Something good comes out of everything and I think the good thing for me today, besides being able to have medicine, was seeing my boss being empathetic for a change.

Now I can move on from this and be optimistic again. This whole situation has made that hard. I was too depressed to even post here, and that's not good.

There's not much point to this thread, after reading it, but I just had to write it because it's been consuming me, and today was the climax. Thanks for listening, and I hope everyone is well!
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April
dx 9/07
Avonex started 11/07
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Old 02-20-2008, 08:29 PM   #2
MSJayhawk
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Join Date: Sep 2007
Location: Kansas, USA
Posts: 2,231
Re: Insurance Problems Figured Out

Congratulations on fighting the just fight (bellum justum). It is pitiful that red-tape causes pains.
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Old 02-20-2008, 08:31 PM   #3
MSNik
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Join Date: Sep 2006
Posts: 4,952
Re: Insurance Problems Figured Out

HI April, there was ALOT of point to the thread, besides the obvious- you needed to vent...a couple of weeks ago, you were talking about what a jerk your boss is...and now this. Maybe there is a reason you didnt quit when you were considering it. I also remember that you were talking about him retiring this summer....things happen for a reason.
Im glad you were able to straighten this out- and yes, makes you wonder how many people go thru exactly what you describe without the ability to fix it, like you did...good for you.
Im also happy to hear you "handled" today- medically speaking..April, I know there are really bad days healthwise, but there are also really good days. I dont know if I told you this before, but after I was on Rebif for 6 months, my energy level came back and I started feeling more like me! Hopefully it will happen to you too...hang in there- things get better.
Hugs
Nikki
__________________
RRMS- dx 06
Rebif since 06
"Every New Beginning Comes From Some Other Beginning's End"
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Old 02-20-2008, 09:09 PM   #4
april1848
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Join Date: Oct 2007
Location: Ohio
Posts: 940
Re: Insurance Problems Figured Out

Thank you both for your replies! I'm still waiting for my meds to...well, stop ruining every weekend. I'm glad to hear, Nikki, that you felt good after six months. I've had a really good MS week, but the side effects from the avonex are still bad. I do everything I'm supposed to do. I'm trying to be patient.

For a minute day I was asking myself why I am I fighting to get this med that makes me sick and might not even be working? But I really don't have a choice! I know I may switch to a different medicine some day, but I don't want to do that unless I give this one a good chance. It's been 14 weeks. I could also go off meds altogether, but like I said, I want to give it a chance.

My boss has been pleasant the past few days, and it's been nice working with him again. Maybe it's getting easier for him.

But it's good to know the medicine may actually work!
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April
dx 9/07
Avonex started 11/07
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Old 02-20-2008, 10:01 PM   #5
MSNik
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Join Date: Sep 2006
Posts: 4,952
Re: Insurance Problems Figured Out

April, 14 weeks isnt that long, even if it seems like it is....all the MS meds require 6 full months on them before they can tell you if they are working or not. An MRI sooner, wouldnt be fair....when you hit the 6 month mark, you can request an MRI be done and see if any new lesions have developed and re-evaluate how you are hanlding the drug..
I think youre going to be fine...and Im very proud of you for handling today so well...
hugs
N
__________________
RRMS- dx 06
Rebif since 06
"Every New Beginning Comes From Some Other Beginning's End"
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