Tuesday, April 5, 2011

Insurance

There are 3-4 different blog posts floating around in my brain from incidents today, but I think I'll go with the insurance one. The others require more reflection, and I'm tired tonight. Daughter is on my insurance, but she also had medical assistance as a disabled adult. My insurance is primary, so basically MA picks up co-pays on things. When we moved her to Capital, I had to pick out a plan for her through one of the private insurers MA partners with. I picked out a plan where the doctor I'd gotten her was a provider. Then we got her new card from the MA plan with the name of a different doctor on it. I had to call twice before they sent me a corrected card.


When I went to get her prescriptions filled in January, the co-pay had gone up to over $200 a month. Her new MA plan requires prior authorization for a number of her prescriptions. I called about this, and asked them to send me the forms to take to her doctors to get the prior authorization. Nope. They couldn't give them to me, but the doctor's office would have them and know what to do.


So I started asking the doctors' offices to do prior authorization. I had to convince the doctor's office she needed these prescriptions. We've gone through a number of different birth control prescriptions before we found one that worked for her. I didn't want to start that process again. Her plan doesn't like insulin pens. I'm willing to use syringes for her night time insulin, but the pens are much more convenient for before meals, especially since she has to draw up her own insulin before lunch. Syringes can be tricky. MA likes a different brand of meter than my insurance company. Right now we both use the same meter. I want to continue using the same meter. The Nurse Practitioner didn't see that as a medical reason and refused to get a prior authorization for that. Okay, then put her on mail order for that (my insurance company penalizes us if we don't do mail order, but the mail order company doesn't take MA). She said she'd do that.


MA didn't like the antibiotic for her kidney infection. They required prior authorization. I just paid the $80 co-pay. I wasn't going to allow permanent kidney damage while they decided whether she really needed such an expensive antibiotic. I went in last month expecting that with the prior authorizations, her co-pay would be back to about $20. Wrong. So we saw the doctor last week and I asked what had happened to them. The nurse called the pharmacy and the pharmacy said she didn't need prior authorizations for any of them. I explained that she didn't for my insurance, but she did for MA. She said they'd take care of it. Yesterday I got a message from the pharmacy. Apparently I will be getting a refund eventually, but it has to go through their corporate. Okay, sigh of relief.



When the mail order place didn't get a prescription for her test strips, I asked them to request one. Today the test strips finally arrived (a month after I began trying to get them switched to mail order). The new prescription is for half of what she needs. I wanted to cry.


After a good night's sleep, I will call the doctor's office tomorrow. When the nurse tells me she's testing too often, I will ask her which test she wants me to eliminate. Am I supposed to guess on her blood sugar to calculate her insulin before a meal? Should I tell her not to test in the afternoon to see if she is really low and needs a snack? (She is about 25% of the time-- working on getting that figured out). Maybe they'd prefer I'd send her to bed without checking to see how big a snack she needs at bedtime. I'll try to be patient as I explain it all again, I really will, but there are times when I'm not feeling very Christian about the whole situation.

4 comments:

The Other Mother said...

Hi, Thought I'd introduce myself. I've been reading your blog on and off for a while. My background is in human services, with much of my career working with adults with developmental disabilities. And I am currently in year 3 of a 3 year lay ministry program through the UCC. Glad to hear the birthday party was as much of a success as it could be and I'll be first in line with you when you do battle with the insurance company.

Reverend Mom said...

Nice to meet you, Other Mother. You are a glutton for punishment-- foster and adoptive care plus ministry? Haven't you learned anything from reading my blog? As you know, I love my life, and I hope you will find ministry as rewarding as I have.

Dan.Eliot said...
This comment has been removed by a blog administrator.
Magnolia Perez said...

What a neat post! Looking forward for more post from you. Thank you for sharing!