September 9th surgery

[mabeckoff]

I am so down in the dumps. This insurance is a nightmare. I have been without my Lyricia and Cymbalta since last weekend and the earliest I can get it is Monday.
The insurance company does not let you call the pharmacy section directly. You have to call the regular number and then they put you on hold while they call the pharmacy dept. They , also, do not know how often these drugs need to pre-certified. It could be every month. If I buy these drugs and pay cash. they will not pay me back.

As for the CAT Scan, the earliest I will get the approval is next Wednesday. It could be as much as 2 weeks. I cannot imagine how long they will take to give approval for my surgery. I really doubt I will be having surgery on June 3rd. I would very surprised if I even have the cat scan by then.

Then they tell me that one of my son's doctors is not covered. I thought that the whole point of a PPO was that you could go anywhere.

[JenniferG]

I feel for you Melissa. Life gets more complicated every day. I hope you can get this all worked out.

[mabeckoff]

The last three days have been a nightmare. Every prescription that either my son or myself take needs to be pre authorized. I picked up my son's face cream today. When my son had BC , I got three tubes for $50. Today I paid $268 for one tube. I have not had my meds for almost a week and have been having melt downs every day. So I bit the bullet and paid for my Lyrica and my Cymbalta to the tune of $600. I did speak to a higher up at the company and he told me that the chances of me having surgery June 3rd is not looking good. Even though it is a PPO, I have to get Xrays pre-authorized. So I will have to see Dr B on May 14th and then come back to get the Xrays and then again come back to see him for a total of 2 co pays . What a rip off. This is such a horrible healthcare company. The hospital told me that this healthcare company is the worst to work with.

This week started off on such a good note and is ending down in the dumps

Thanks for listening

[jrnyc]

i am so sorry you have all this crap to deal with...
insurance companies seem best at saying "no" and "no, that is not
covered"
i have one now that NYC insisted it's retirees take...
and already one good scoli surgeon in Manhattan won't take the
insurance...and i have the PPO version of it...
it is a NY based company, too, so why a Manhattan doc doesn't
want to take it is beyond me...
i would gladly have kept the pricier insurance that i paid twice as
much for that i had previously, but nasty Mayor Bloomberg wouldn't
allow it...
so you DO have all my sympathy...
i hope they come around for the surgery....

jess...and Sparky

[mabeckoff]

i am so sorry you have all this crap to deal with...
insurance companies seem best at saying "no" and "no, that is not
covered"
i have one now that NYC insisted it's retirees take...
and already one good scoli surgeon in Manhattan won't take the
insurance...and i have the PPO version of it...
it is a NY based company, too, so why a Manhattan doc doesn't
want to take it is beyond me...
i would gladly have kept the pricier insurance that i paid twice as
much for that i had previously, but nasty Mayor Bloomberg wouldn't
allow it...
so you DO have all my sympathy...
i hope they come around for the surgery....

jess...and Sparky

Mayor Blumberg seems to be full of himself in many matters, it appears. I guess that I have been lucky for the past 20 years I have had great insurance. BCBS paid over 1 million dollars for my first surgery with Dr Bederman with no issues and this company is giving me a hard time authorizing a CAT SCAN.

Thanks Jess for listening

[susancook]

Melissa: I have little patience in dealing with insurance companies when I feel well, and find it impossible when I am in pain. Sorry that you need to fight with them to get your care.

You have come a long way and are amazingly resilient. You are one tough lady!

You are always welcome for our (my) listening. You have been supportive of me and I have appreciated your kind words.

Take care, keep posting, and let us know how you are doing.
Hugs, Susan

[mabeckoff]

Thanks everyone. It is just the worst situation ever

[Susie*Bee]

I am so sorry this is going on now for you, Melissa. Hang on to your faith. One of these days things will just have to start going right. As all of us know so well, you exhibit such strength time and time again. I am praying for you. Hugs, Susie

[mabeckoff]

Thank you all for your good wishes and encouraging words. I purchased and paid lots of money for my Lyricia and Cymbalta. I am glad that I did because I do feel much better

[mabeckoff]

I finally had a good night sleep because of the cymbalta.
Tomorrow I get to fight the insurance company again

[Susie*Bee]

Glad to hear you feel better, but sorry you had to pay "through the nose" to be able to do so. Hopefully the insurance company will come through sometime??? Thinking of you. You've been through the mill-- so many times!

[JenniferG]

Glad you got a good night's sleep - so important. Good luck with your battle. It seems at times, these insurance companies are a law unto themselves. It's terrible how much power they have over our lives. Australia is going the same way, unfortunately. If we have a change of Government in September, and it looks like we will, it will be sooner rather than later.

[mabeckoff]

This insurance Company is the bane of my existence. I guess that I have very lucky with the last several insurance companies.. I hope that these prior authorizations and approvals get sorted out soon

Thanks everyone for your kind words and encouraging comments.

[susancook]

Again, you are awesome and hang in there! Nobody will defeat you. Keep us posted. As was mentioned above, keep the faith and get your sleep. When things seem overwhelming, stop and take a deep breath and say to yourself, "I am strong, I can do this". Go girl!
Susan

[mabeckoff]

Again, you are awesome and hang in there! Nobody will defeat you. Keep us posted. As was mentioned above, keep the faith and get your sleep. When things seem overwhelming, stop and take a deep breath and say to yourself, "I am strong, I can do this". Go girl!
Susan

Thanks Susan. I can always use a pep talk