Quote:
Originally Posted by poohbear_nc
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As many of you know, I suffer from migraines. ......... I finally found the one perfect medication for me - it knocks out an oncoming migraine in 20 minutes with tolerable side effects. For me - nirvana (of sorts).
Well, last year one of the hundreds of currently available migration medications became available in a (cheaper) generic form. My health insurance company insisted I switch to it or else they wouldn't cover migraine med costs anymore. So I switched to it (I had tried it in the past - it didn't work) - and again proved it didn't work, and had my doctor file a medical exemption form with the insurance company, and, after several months of agony, got to take my proper med again.
Well, this year,
1. The insurance company first decided that rather than allowing me to have a month's supply of pills for a single copay, I had to instead get a weekly supply, one at a time, each time for the full copay. So, instead of paying $60/month for my pills, I was now paying $240/month for the same number of pills.
2. Then, the insurance company sent me a notice that the med I was taking, which is in my medical record as the ONLY effective treatement for me, would no longer be covered ... period. I could continue taking the pills, but I would be responsible for their full cost ($40/pill). .......................
And I waited ...
And called my doctor's office - who had sent in all the requested paperwork. And then called the insurance company, which is now denying they ever ordered me to sign up for mail order delivery ... despite the fact I have saved all the correspondence. Who is now "investigating" the situation ...
while
I wait ... ..............
In the meantime, all I can do when I am stricken with a migraine is to take my prescription Vicodin .... which makes me unable to drive or go to work.
And this is perfectly legal for the insurance company to pull.
All I can think of to do is to fill my narcotic prescriptions (which ARE covered by the insurance company), sell them on the street, and use the money to buy the migraine meds.  ....... |
That is an awful situation. And that happens in our country as well.
Although there's the same substance in a generic tablet, it is possible that it doesn't work as well as the original, That has to do with the added substances in it, or the way it is processed.
Patients that have organized themselves in some kind of association, sometimes manage to get ' their' medication back. It's difficult, but not impossible.
We have an excellent health system, but we pay a lot of taxes.(50 % in our case)
The insurance companies have a lot of power in health care, but their power is restricted by the State. By law the insurance companies must offer basic healthcare (no frills) for all (they
cannot refuse the basic care for a client) for about 100 euro's a month.
Everyone in this country is insured for the basic costs, no matter what.
Our family (3 persons) pays 340 euro's per month; all costs covered, except some dental work and 'luxury' things like cosmetic surgery and so on (just for fun-things I mean).
These last few years,
some people with complicated or chronic diseases get their own budget from the insurance; they can spend it on the care they want for themselves. It's a choice they make, with our without consulting their physician.
Some treatments are restricted, for example physical therapy to 12 treatments, I think. After the 12 one has to pay something (not the full amount though, if a doctor perscribes these treatments.)
And we have a so called ' own risk'; that is about 160 euro's a year and after that 160 euro all is paid. One pays that amount only once in a year.
Pooh; I find it very unjust what they are doing to you and I do hope you can work something out. Hang on!
