So here I am, what two or so weeks later and I'm getting calls from my specialty pharmacy saying they're waiting for pre-auth from my doctor. I call bullshit. I know that pre-auth comes from the insurance company, cupcake, not the doctors. Now, if they had said, we're waiting for this ridiculous form that we're making your doctor fill out again because we didn't like how their 'i's looked, I'd of believed them.
I called the insurance company, got the normal "let's transfer you to everyone who asks if you've called the specialty pharmacy yet even though they don't actually make a damn decision." Eventually I got a person. Yay! She asked me if this was a critical medication. My smart ass said, "Well yes ma'am. I actually can't really walk well right now and need to buy a cane so I can actually get around at work." Meanwhile, don't you think it's lovely to see a nurse with a cane?
So she called her super and they called their internal pharmacy dept and I'm to have an answer tomorrow morning. Supposedly.
Hope my patients like my cane. Maybe we can bedazzle it. Seriously, though, I can't really put weight on my left foot anymore. Can't call off work because I don't have the Holy Grail of Doctor's Notes nor do I have any time left.
I'm just gonna past a smile on my face and try not to curse :)
Oh, just call a call from Blue Cross. They're calling and giving my doctor the direct pre-auth line. They said my Doc should have called Caremark. I made them aware that Caremark had claimed they weren't my pharmacy and they had nothing to do with it, which is NOT what Blue Cross is telling me. Fingers are crossed!
Good luck. I hear you loud and clear. I just started all of the authorization process and am finding out my original insurance wouldnt have covered it without a preload of DMARDs but now my new carrier wil based on my Dr's criteria letter for my particular case. I have a gap in my care from the two different companies that I am awaiting ,,,, get this... separate coverage for the fourteen day time frame from now until the first. I won't know for sure until the first of Jan what can be ordered and when. I also have the documentation prepped in case no one will cover it!!! . ARRRGGGGGG
Hope you get your call and your meds ASAP Sunny. I recommend sparkly duct tape..... It sticks to the surface of the cane easier and you can remove it and change it up !!! LOL Wishing you fast relief. I'd cross my fingers too but I do not think they would come uncrossed :)
Well it's been a few days. Have you received any info on your meds yet? I'll get mine all worked out by next week ,just time issues. Thay gave me really good insurance. How are you feeling?
Jane, yeah, I swear they make it complicated so that people just give up. Crazylady (I swear that said crazycatlady, lol) I heard from the doctor's office that verified they were sending in the request on Friday. They were concerned about me being able to afford it, which I appreciate, but I insisted they send the damn request out. I can no longer walk right and made sure the doctor's office knew that. I also made them aware of the new nodule on the right wrist and the chest wall inflammation. Trying to push the insurance company. BUT the toe might actually be gout?? Guess it's a "wait and see" thing. At least I can get some more prednisone today and get some temporary relief. Ooooh, and it's time for my MTX injection tomorrow. Maybe it'll help (not that it has yet)?
Just so down about the whole thing. I feel like a shell of my former self. I don't even have the thumb strength to push in the button and adjust the cane. I had to have the lady at CVS do that. UGH. Couldn't pour the coffee one handed today either. That's a new one. That's why I got so mad with my work. They insinuated I couldn't do my job. I still CAN do my job. It's just painful and I'm dealing. My doctor doesn't feel I need to be on restrictions, and neither do I. I might be a little slower but I'm still a damn good nurse-this disease will NOT take that away from me.
I just spent SIX WEEKS struggling with my specialty pharmacy. They lost the prescriptions, voided others after 24 hrs, then lost prior authorizations from my dr. etc. Finally got the first loading dose of my med 2 weeks ago (Stelara). They copied the prescription wrong and now it's a whole new fight to get them to fill the 2nd loading dose in 2 weeks. I spent about 4 hours a week for 6 weeks trying to get my meds straightened out (and my dr's office is super responsive and works with this company, Medco, all the time, so not their fault). Even called my insurance company and had THEM call and yell at the online pharmacy. I talked to everyone at the online pharmacy, reps, supervisors, pharmacy, etc. It's was a clusterf(*(&*.
I don't know how this saves ANYONE time or money over sending these expensive meds to the local pharmacy. I'm so sorry you are dealing with this too. It's a nightmare. The stress from it definitely caused a flare.
Yeah, Marietta, I feel ya loud and clear. The whole reason I'm in such bad shape right now was because my old specialty pharmacy said they didn't have the script from my old Rheumy's office. I called, they had sent it in. I called and spoke to the specialty pharm-and they said that the dose form wasn't specified. So I called back and left messages, I got no where. I spoke to the one lady at my doc's office-she said they'd faxed the form back. Back and forth we went. The pharmacy supervisor called and left messages at the Rheumy's office several times but got no call back. I spoke to the office staff at the old rheumy's office-she said "We don't call people back." Eventually I got out a pen and paper and wrote down EVERYONE the pharmacy had talked to and finally got a hold of a competent person at the old rheumy's office who would listen to me. The problem was that the box wasn't checked on the form specifying which dose form he wanted; auto-inject or syringe. That's all that was needed. But for an entire month it was back and forth-I do blame the old rheumy's office partly because if they would have just taken the time to either pick up the phone or call them back they would have realized what the specialty pharm wanted. But a month with no Humira was enough to start my body building up an antibody to the Humira.
Wow Sunny, that is just incompetence multiplied if you ask me. As we care providers know, the first rule of this business is to cross the tees and dot the i's or this is what happens. Those forms are not that difficult ....I just did mine and they are not small print or anything, just a row of choices. I hope you have a good immune response for the restart. :) I am so sorry you have had to go through so much garbage lately. Just because it takes two hands to pour coffee some days in no way diminishes your nursing skills. Bad hands in no way impede your good instincts and pleasant bedside manner. Your patients need you no matter what corporate says. It makes them feel less vulnerable when their care staff isn't so darn perfect.
I just returned from the neurologist.After we spent half an hour discussing my Migraine treatment he informed me that I have severe nerve damage in my lower back and legs. ( duh I fought with his partner over this last year) However, this new gentleman was extremely cooperative after I showed him all of the printouts from my reumy ( L6&L7 have erosion's) and he is coordinating care plans with her so that I will get relief for all !!! We do a nerve mapping next month and then an MRI on my lower back. I feel like Joan of Arc after a three year battle -Today I took the hill and conquered the last of the misdiagnosis....
Now I have to change my name. although I am sure timberwolf would tell me to keep my crazy on ..it's invigorating some days...:)