A Funny Story

No, not about pumpkins this time. There will be more of that to come with Halloween just around the corner, don't worry.
And actually the story isn't really so funny. More like infuriating.
Two weeks ago I went for my follow up appointment with the neurologist. Everything went great, nothing really new to share....the doctor said that before he gives me a prescription for the migraine medicine to just check with my insurance to see which one they cover because some of them can be pretty pricey and then he could just call it in. Sounds so simple and nice of him to think of our finances. Right? Ugh, so wrong. And so not simple.
Michael found out that all we had to do for insurance is have the doctor give them a pre-authorization for the prescription and then they'd cover it. Um, what a lie. When the nice medical assistant to my neurologist got back with me, she said that the insurance company denied the pre-auth for the medication. Ooooo-kaaayy. She advised me to call and see which of the medications that they do cover (and then gave me some possibilities...which included a couple that I had sampled and would be ok with taking).
When I finally got Traci from Blue Cross on the line, she explained that the Zomig that I was trying to get prescribed was denied because I first had to take some other "preferred" options first. Um, excuse me? Traci, would you mind faxing me your neurology credentials real quick?? When she listed the two "preferred" options, one being Imitrex, I said, no way, I've taken that, it doesn't work, I DO NOT WANT THAT. And then she grilled me on who prescribed it to me and said that Dr. Silverboard (my actual neurologist) would have to make a note on its side effects on why I can't take it and that my other option is something called Amerge. Never heard of it, since that is not one of the two samples my neurologist gave me to try or on the list his medical assistant gave me. And that I didn't go to a neurologist to just take something random that I don't know if it will work and what the side effects will be. Oh, well, explained Traci, the non-doctor, I have to take those medications first before I can get any of the others approved. At this point I am angry and trying not to cry at the same time. Not a good combo for Traci, I must say. I tried to explain why I was going to a neurologist in the first place, to actually find a way to get rid of my migraines, and this medicine (that she was not letting me have) actually worked. I asked her if she ever had a migraine or if she ever tried to function with a one year old while experiencing a migraine. She ignored most of that but did apologize and repeated that once there are notes from the doctor on why the "preferred" medications don't work then maybe they can approve the other options. Traci and I didn't end the conversation on good terms, with me getting the crappy end of the disagreement.
So, isn't that very interesting? I have spent $100 in co-pays to see a neurologist twice (because a specialist is more than a normal doc) but yet all I really had to do was call up Traci at Blue Cross and say, hey, I get migraines, what should I take for them?? If I fall and break my leg, should I just text a picture to Traci and say, cast or no, what do you think??
I understand that insurance doesn't want to pay a lot covering things, prescriptions, hospital visits, etc. I definitely get that....several years ago I was in the ER in Orlando for like 4 hours and it took me almost a year to pay off what insurance didn't cover. But I guess I just don't understand how they can decide that what a doctor prescribes or says or advises is just a complete denial. Michael said maybe we can just see how much the Zomig costs and get the crap prescription from insurance that they will cover and then also have the Zomig in case the other doesn't work....but I think it is well over $100 for like 9 pills....yikes, maybe not an option. I also don't see why insurance won't even cover some of it. And then let us decide if we can afford it, or have to try the lesser prescription first. I guess insurance is one of those things I will never understand. And will probably give myself a migraine if I even try. And I definitely want to avoid migraines, if I can, at all costs now, since who knows if my medicine will make them go away!!
One final thought....Blue Cross, you kinda suck. Today you did NOT help me out when I needed you. Glad I am not a sickly person.