Fuck you, insurance! (lame, whiny)

We’ve all heard the story about my stomach problems, and the ulcer, and the treatment of it, etc. Nexium for life, apparently (problem #1, insurance won’t pay for the much cheaper Prilosec because it’s available OTC). So I have reflux, BFD. Some people are dying of bone cancer.

Fuck those people. I don’t have bone cancer.

You can all see where this is going. A customer service complaint. I call my mail-order service a week and a half ago (2-6) to order a refill. I only have a week’s worth of medicine, so I tell them to overnight it so I don’t run out. “This transformers toy is COOL!,” the guy says, and then corrects himself to say "We’ll get it ready for you, Mr. bear. I wait exactly a week and call back. The insurance needs a Prior Authorization, meaning that they want my doctor to fill out some paperwork with them to cover the drug, because they will only pay for 90 pills in a rolling year period, and they assume that my doctor is an asshat with a pen and pad, and does she really want me to have Nexium? (Yes, she wouldn’t have given me a year’s worth of refills if not!)

So I ask if they can authorize me to get some filled at a local pharmacy while I’m waiting for that to go through (PAs can take days or even weeks sometimes). “There’s a stick in my ass!,” said the lady on the phone, and then corrected herself to say "Yes sir, Mr. bear, give it 24 hours and get your doctor to give you a prescription to take to the local pharmacy. This is no problem, because I have a backup prescription filed away.

Today I go to fill the prescription (in the pharmacy that employs me!) and get a rejection message. Refill too soon, because my asshole insurance PROCESSED THE CLAIM for the one that they need a PA for, even though I can’t have the meds until they get the damn thing done. Call the company, get an override code, and then I can’t fill it because I need a PA.

A what? PA? THAT’S WHY I NEED THE GODDAMN LOCAL FILL! If they had told me about it to begin with, I wouldn’t need to get some at a local pharmacy. So I talk to the guy, and get transferred to “customer care”. The person there transferrs me to my mail-order service. Mail order can’t do anything because the claim I’m running is through the retail service (I have caremark for retail, medco for mail order, blue cross for medical, all on one card that doesn’t mention any of that.) Send me back to retail. Speak with a supervisor. At this point, it’s been an hour and a half, and no one can help, and the pharmacy closes. Each person suggests that I just pay for the two weeks out of pocket.

I call the last number suggested to me when I get home, and that person can’t help me, so I ask for a supervisor. She assures me that I can just pay out of pocket for the couple of weeks I need while I’m waiting for the PA. I ask if there’s no recourse for the original mistake that the person who took my order without complaint. Nope. I ask her what people who take medicines that are actually important do when this happens, and she says that they just pay out of pocket.

LISTEN, CUNT. My medicine is almost 200 dollars for a two-week supply. Even if I just got a few days, I’m looking at 40 or 50 bucks. (Economy of quantity, you see!) There’s nothing anyone can do, and if I eat any more tums, my asshole is going to start looking like a fun factory.

This is exactly why I’m so reluctant to switch to mail-order refills.

That sucks, chaoticbear. People really have to pay out of pocket when something like this happens? Even if they can get reimbursed later on, they might not have the money to spare. I know a few people who struggle just to come up with the insurance copay for their meds.

Is there a generic form of Nexium that would work for you? It might save you some money while you get this mess sorted out. Good luck!

There’s a generic of Prilosec, which is basically the same drug, but they don’t pay for it because I can get it OTC.

Would the OTC Prilosec help you while you wait for your prescription?

I came in to vent and people are giving me sensible suggestions? What kind of place is this?! :stuck_out_tongue:

Yes, but at four a day, I’d still be spending almost 30 dollars for a week’s worth. I’m actually OK on medicine, because I work in a pharmacy and the pharmacists are lending me a few days’ worth until this gets sorted out. I just hate that I’m having to go through this.

Sorry, I know that’s annoying. I forgot we were in the pit.