Wednesday, December 15, 2010

Why you wanna give me the runaround...

I have to remind myself every day how lucky I am to have a perfectly healthy little boy.  I realized recently that I know several mommies who have not been so lucky with their little ones and have had the misfortune of hospitalizations, ER visits, and surgical interventions for their little ones in their first precious year of life.

With our little man, our only big battle has been with the nasty Reflux Monster who came to visit Little Mr. Grunts A Lot when he was just a tiny guy and which returned on Sunday with such fervor you would have thought LMGAL ate an entire all-you-can-eat Mexican buffet.   The only way I can describe LMGAL's newest grunts is that they sound like someone screaming with their mouth closed.  Baby cried.  Mommy cried.  It was awful.  And that was just a little indigestion.  Can you imagine what those mothers go through whose children have unexplained pain?  Or pain that has no relief?  OR, pain that has relief, but they can't afford the medications/treatment to help them?

And so begins my very first battle with my health insurance company.
After the night of the "silent screaming," I called my pediatrician first thing in the morning and talked to a nurse about what had been going on. The nurse was super sweet and awesome. (Again, I love my pediatrician's office!)  She told me she would call in a script for Prevacid to our local pharmacy and I planned to swing by after work to pick it up.

Or so I thought.

I was told by the 15-year-old pharmacy tech that for some reason the system kept timing out when they were trying to get an approval from the insurance company.  She said since this medication is a compound (compound - from the Latin, meaning pain in the ass) they don't mix it up until they get the approval *just in case* it doesn't go through.  The 15-year-old was perfectly nice and said she would be happy to give me a call as soon as she heard back from the insurance company. 

Also, understand that I work in one of those jobs that pays you hardly anything, but that you put up with it because the benefits are "SO GREAT."  Up until this point, I have not had a single issue with my health insurance.  It's awesome.  So, when she told me she was having trouble, I wrote it off as some stupid computer issue and figured it would be resolved without any cause for concern.

So, I went about my evening (which included my yearly visit to the medieval torture known commonly as "eye exam") and shortly after they had attempted to remove my eye balls dilated my eyes and checked me for glaucoma, my phone rang.  It was 15-year-old pharmacy tech saying that she looked into it and my son is "no longer active" on my health insurance.  What.  THEHELL.  I knew this was a mistake and even the 15-year-old said she figured they just did some early "house cleaning" since it's close to the end of the year.  She suggested I call the insurance company myself to try to get to the bottom of it.  I asked her if it was possible for them to fill the prescription, for me to pay for it out of pocket, and get a refund later.  She hesitated and said, "Yes.  We can do that...but ma'am?  This prescription is $318.94."  WHAT.  THEHELL.  I shot her a quick, "Thanks, but no thanks" and immediately took the skewers out of my eyelids  put my new contacts in so I could return home and have a "Come to Jesus" with my insurance company.

Couldn't I just buy it on

So, the 15-year-old pharmacy tech was actually awesome, so I don't know why I have to belittle her by calling her that except to say that our local pharmacy looks as though it is run by a bunch of kids in a high school chemistry class. I always want to ask them where their teacher is.  (Just more proof that I'm getting older.)  And anyway, she's probably every bit of 16. 

All this to say that little did I know, dealing with a high school aged pharmacy tech wasn't going to be NEARLY as grating on my very last Mommy Nerve as having to speak to the pre-teen who answered the phone at my lovely insurance company.

High Pitched Voice: "Like, hi.  This is [insurance company].  Like, what's up?"
Me:  "Um, yes, I have a question about a prescription that is being denied for my son because it says he isn't active on my policy, but he is or at least he should be."
High Pitched Voice: "Ewwwww.  Medicine?  YUCKY!"
Me: "Can I talk to your mommy, please?"

Okay.  So it wasn't exactly like that.  But, after the tween who answered the phone was able to confirm that yes, my son is still covered by my "awesome health insurance" I tried to get her to figure out what the deal was on the denial for this prescription.  In order to do that she needed to know the name of the prescription.  I told her it was likely the generic for Prevacid because that's usually how it works with our formulary.

Tween: "Yeah, but like, what is the name for that?"
Me: "I don't know.  It's just the generic for Prevacid."
Tween: (lots of silence) "...well, like I need you to tell me the name of it."
Me:  "Well, as I didn't go to MEDICAL SCHOOL, I have NO IDEA what the generic name for Prevacid is.  But, I DO know that my son is in PAIN and he NEEDS that medication, so I NEED YOU TO TELL ME WHAT IT IS."

And then she says, and I swear to blog, if I could have reached through the phone and wrung her little neck...

Tween: "It's, ugh.  I can't pronounce it." (giggles)
Me: (have thrown the phone out the car window and am driving maniacally down the highway screaming obscenities)

So, once we've figured out what it is, all she can tell me is, like,  "You've exceeded the maximum."  Though for a "Benefits Counselor" (which was her title, evidently) she couldn't tell me diddly squat about what, like, THEHELL that means.  Her only suggestions is to, of course, call the pharmacy and request that they call the insurance company and request an override.

So.  I do.  And they say to call the insurance company and suddenly, I am engaged in that scary health insurance spiral that I've heard about where everyone is continually passing the buck and telling you to call someone else until before you know it you're driving your car into a ravine.  Or, you know.  Not.

EVENTUALLY.  I talk to someone over the age of 18 (at least I'm pretty sure) from the pharmacy who was willing to try (not after I had to explain to her that my son does, in fact, HAVE health insurance) to request it from the insurance company.  She, as far as I am concerned, is Master of the Universe, since she called me back roughly 5 minutes later.

MOTU: Hi, this is the pharmacy.  I got it to go through, no problem.  Sometimes they give you trouble when the cost is that high, but we're going to fill it now...
MOTU: ...but, I have some bad news.
Me: (facepalm)
MOTU: Since this is a compound (remember: compound=pain in the ass) we can mix it up right now, but it has to sit for 4 hours before you can give it to him. (Current time is 8:00 pm CST) So, you'll either have to wake him up to give it to him...
MOTU: ...or you can just give it to him tomorrow.
Me (to LMGAL): Sweetie? You're getting the Zantac tonight.

So, mommies out there with similar problems or problems so big they don't even compare to my 24 hours of annoyance - I have all the sympathy in the world for you.  My son couldn't get the medication he needed when he needed it because the insurance company decided to play hardball for a grand total of 4 hours.  And this is when I'm lucky enough to have "good" health insurance.  Imagine what those mommies go through that don't have the "good" insurance - or worse, don't have coverage at all.  It's just too awful to think about.

Also, for those who are wondering.  After ONE day on the Prevacid, LMGAL was "a totally different kid" according to his babysitter. 

Guess I need to start coming up with a new nickname...


  1. Found you at the Mom Blogs. Sorry for the PITA you went through, but you totally had me LMAO. Totally been there done that.

    Have to ask, how did you get the "you like" boxes at the bottom?

    I'll be back! Love your blog


  2. @Azhita

    Thanks for finding me!
    So, the buttons at the bottom can be set up through your Blogger Dashboard under the "Design" tab. If you click on the "Edit" button under "Blog Posts" on the home screen for Design, you'll get a pop up box that gives you lots of different options for things to be at the bottom of your posts (comments, sharing, etc.) Click the checkboxes for the stuff you want. The "You like?" part is customizable for each blog. That's the title I chose for those three (funny, interesting, cool) buttons. You can choose to call them whatever you want or use the default.

    Glad you liked my post and for becoming a follower. Giving you a follow back :)


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