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 Until she told me that they DID receive some test results but that they were "all outdated".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 I started screaming "Outdated?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 How the hell is this outdated?"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.