Friday, January 23, 2009

FINALLY...

Well...finally. Apparently my daily calling, threats of lawyers, and overall psychotic raging lunatic behavior finally was enough to scare some sense into my insurance company. I got a calls from my neurologist's office today- my Copaxone prescription has FINALLY been approved. Kinda sad that is was prescribed to me a month ago, but it's better than never, right?

So this is going to be a relatively short post, I mostly wanted to let everyone know I am finally going to get the medication I so desperately need. I am hopeful that this is the first step at regaining some kind normalcy in my life- or at least a new basis for 'normal'. I should have a confirmed delivery date by Tuesday, I'll then call the nurse to set up a time for her come, and the daily injections will begin.

Be well all!
-Mis


Friday, January 16, 2009

The insurance provider, Health Plan of Michigan - SUCKS!!!

Yeah you read that title right, I am so PISSED right now I am spitting nails. And, I am naming names. Why? So maybe I can save someone else out there the huge mistake of EVER getting coverage from this insurance company, Health Plan of Michigan.

I just received a denial letter in the mail from them. A letter denying me the treatment I need to keep my Multiple Sclerosis from getting worse. Here is the official reason:

Copaxone KIT (medication used to treat multiple sclerosis)

Health Plan of Michigan does not cover Copaxone without prior authorization. There were no specific details of your history, no notes from the neurologist (specialist), no current MRI results, and no information regarding the severity of the diagnosis. Please contact you physician to arrange for these medical tests and information to be submitted to Health Plan of Michigan prior to the reconsideration for approval of Copaxone.

The legal basis for the decision is 42FR440.230 (d)

I... was simply speechless. I called them of course. At first, I was very civil and nice. Until she told me that they DID receive some test results but that they were "all outdated". It was at that point I lost my mind. I started screaming "Outdated? I JUST had an MRI showing two active lesions on my brain in October, and a spinal tap in December. How the hell is this outdated?" She then went on to say they didn't receive my neurologist's notes proving the severity of my condition. I seriously wanted to reach through the phone and strangle the woman. The severity?? I HAVE FREAK'N MULTIPLE SCLEROSIS!! How severe does it need to be? Isn't the idea to keep it from getting severe so I don't end up crippled and completely disabled??????

So I called my neurologist's office... again. Paula apparently got the same letter I did. My first words out of my mouth when she answered the phone "It's Melissa again... and Health Plan of Michigan seriously sucks". Her response was "You're just now figuring that out?"

She said she's never had an insurance company need more than the MRI results and spinal tap results to approve medication for MS. Paula said "I mean honestly, you have brain lesions and the markers well within the indicators of MS in your spinal fluid. I don't know what else they could possibly need as proof". She was in total shock, and honestly, pretty pissed off too. She said the doctor was seeing the last patient of the day when I called, but was already aware of the letter and going to be digging through her files to try to figure out what Health Plan of Michigan needs to get this thing through.

I seriously don't know if I want to scream, cry, or both right now. This is now the second time Health Plan of Michigan has tried to deny me treatment I need. Last March they denied the surgery I need to fix my severely herniated abdomen. Now they are trying to deny me the medication I need to treat Multiple Sclerosis. Unfreak'n-believable.

I tell you what, if this isn't rectified and fast, I AM getting a lawyer. I am not going to sit back and let this group of keyboard bashing monkeys essentially cost me my life to save a few bucks.

So let this serve as a warning: If you stumbled onto my blog searching Health Plan of Michigan because you are considering them for health care coverage- DON'T DO IT. They are by far the worst insurance company I have ever had the unfortunate luck to be stuck being covered by. They do not give a damn about the patients health in the least. All they care about is doing whatever they can to save themselves some money, and they have no hesitation denying treatment that is critical to health, and even life itself, in order to do it.

I'll update again as this latest battle continues.
-Mis

Tuesday, January 13, 2009

Inusrance companies suck!

You know, just when I think this whole process couldn't be more of a pain in the ass... it is.

It's been 3 weeks since my doctor prescribed Copaxone. And I still haven't received the medication. First, it went through the Copaxone supplier. I've spoken to them about 3 times, received a ton of info in the mail, got the name and number of the nurse who's supposed to teach me how to give myself the daily injection. Then, it was sent to the home delivery pharmacy
that my insurance company requires me to use. This... is where the headaches started.

I first spoke to them about 2 weeks ago, verfiied all my information, and was told they'd call back "in a day or two" to let me know the delivery date. I wait 5 days, nothing, call again. This time I'm told they need more information from my doctor, and they'll "call back in a few days". I wait 4 more days, call, same bullshit. I call back again today...and get this: They tell me it was denied!!

This dude then proceeded to tell me "there wasn't enough proof of the illlness to warrant the prescription requested". I almost blew a gasket. I go "Ummm... I have Multiple Sclerosis. I have MRI results showing 2 active lesions on my brain, as well as test results from a spinal tap that are positive for Multiple Sclerosis. What...do you need me freak'n dead so they can do an autopsy and prove I have it that way?"

He stammered a bit... clearly in shock that this apparently crazed woman on the other end of the phone was losing her mind. "N..No....No. Maybe your doctor can simply fax the test results to us so we can verify and process your claim?" My rage grew even more as I responded "Maybe someone over there should get their heads out of their asses long enough to have at LEAST called me when it was denied, or maybe even called my doctor themselves to straighten this out? What, are you people so stupid that you think neurologists are running around prescribing Copaxone for shits and giggles? I mean c'mon...every junkie on the street is just DYING to shoot up with something that will make them have hot flashes, muscle aches, and possibly puke"

Needless to say...the phone went silent at that point. I'm certain he likely had me on mute while he turned to the person in the cube next to him telling them he had some psycho bitch on the phone. I finally just said "give me the damn fax number" to which he gladly provided I'm sure just to get me off the phone.

So... I called my doctor's office. Surprise surprise, this was all new news to them. Paula, the receptionist there (who, btw, is an angel... I simply adore her) was in shock. "You mean you haven't started your meds yet, because of this nonsense?" I sighed and said yes. She then proceeded to fax both my MRI and spinal results to them while on the phone with me. She told me Dr. Samuels was with a patient at the moment, but she would inform her as well and have her call the insurance company personally to make sure this stuff stops and I get my medication.

Now... I'm back to the "processing the claim" part of the red tape...again. I swear to God, if I don't go completely postal and start bitch slapping the hell out of people before this is done, it's going to be a miracle. I have now been trying for about 6 months to get the treatment I need for MS. It's going to take 6 months of being on the Copaxone before I start seeing results. The last thing I need is my moronic insurance company once again screwing everything up and postponing it even longer. It's just ridiculous.

Which...brings me to my main point. When, in our country, did medicine stop being about the patients well-being, and start being about the almighty dollar? Mind you, this isn't the first time I've had this issue with my insurance company. They also denied a surgery I need last year to repair my stomach. A surgery both my primary care doctor and the specialist I saw said I desperately needed. Yet here I sit, with my tummy even worse, unfixed and in pain. How is it a bunch of yuppies sitting around a conference table, drinking their Starbucks and plugging away at their laptops, claim to know more about ME...what I NEED...to be healthy than my doctors do?

I know I'm not alone in this struggle. Sadly, you read articles all the time about people literally dying while waiting for insurance companies to approve treatment. I don't know what the answer is, but I do know something seriously has to be done in this country to put the care of patients back into the hands of the doctors where it belongs. Insurance companies should not even have the authority to overrule a doctor's more than qualified opinion on what is best for their patient's health, let alone have the power to literally kill a person simply because they don't want to pay for the costly care needed to keep the person alive.

So...that's where I'm at today. Really angry, really cranky, and really wanting to haul my gimp butt to the office of my insurance company and start pimp smacking some sense into people.

*sighs* Be well all.
Mis

Friday, January 2, 2009

In comes 2009

Well, here we are, another new year. 2009. Wow... it seems like just yesterday it was 1989. Where did the time fly away too? It's like I blinked...and got...old. *laughs*

I'd be lying if I said I was one of those optimistic, hopeful people that see a new year as a chance at a new beginning. I look to this new year, and I just feel dread. Yeah I know, it's depressing. But it's honest. I mean, my New Year's Eve consisted of a phone call from the Copaxone people, going over information on the drug and giving me the name of the nurse who's coming out to teach me to give myself the injection. To me, this was prophetic. This is how I will be spending 2009, trying to get my Multiple Sclerosis under some kind of control. I will be spending tons of time at doctor's offices, getting shots daily, and likely fighting relapses. I mean, seriously, how is this something to be 'hopeful' about? My life has changed forever, and not for the better. What's even remotely great about that?

Oh I have an appointment on Feb. 25th with the rheumotologist. I'm still pretty upset about the possibility of Lupus. But, I refuse to 'claim' it. I am holding out hope that there is some explanation for my blood and spinal fluid showing it- besides actually having it. So until some doctor tells me with 100% certainty that I do have Lupus, in my mind, I do not have it. I believe very strongly in God, and the spirit realm, and I believe the body often follows the mind's cues. I refuse to give yet another disease permission to ruin my life. Not that I gave the MS permission, but I am still rebuking the Lupus because I am hopeful that it'll rectify itself somehow and won't be a part of my life. *sighs*... it just can't be. I can't handle having both.

On the upside... I am still holding my own pretty well physically. My eyes have even improved since my last post, I'd say they're about 98% back to normal now. Aside from some occasional tingling in my left arm and hand, and minor dizziness when walking, I'm doing pretty dang good. My only real complaint is some ongoing pain. In my abdomen and right hip mostly. It's really weird, because the pain in my right hip actually started about a year ago. I had an IVC filter put in, and it's given me issue ever since. It makes no sense- the filter is no where near my hip and the only incision they made was on my neck. Yet after the procedure, I literally couldn't walk for about a week because the pain was so bad. It slowly improved, but it's given me issue on and off ever since. The last few weeks it's been really sore again, especially at night. As a result, I'm not sleeping for crap lately, and it's making me uber cranky. (poor Wayne, me cranky isn't fun lol) Wayne wants me to go see my primary care doc for a pain med and something to help me sleep. I'm not real keen on even more drugs in my system, but if this continues, I may have to.

So, that's where I am at the moment. *sighs*

I'll write more another time soon.
*hugs*
Mis