If you look up Frustrated in the dictionary you will probably find a picture of me. My husband’s doctor told us on Tuesday that they had sent a second letter to the insurance company to appeal on Monday. I decided to call the insurance company today to see what the status was. Once again the first person who answered had no idea what they were doing and transferred me to the wrong place and I had to hang up and call back. The next lady wasn’t much better and wanted to transfer me to the prescription place, even though the prescription place wasn’t the one who denied me!
So I ask the lady what the status was. She asked when the appeal was made and when I told her Monday she acted like I was crazy for calling! She told me appeals can take 30 days! 30 Days?!?!?! We don’t have 30 more days to wait! The doctor prescribed this medicine on December 6th! We didn’t even find out we were denied til last week. Biting my tongue, I told her this was really important and I wanted to see if there was any progress anyways! She told me there was no proof of an appeal at all and asked who we even sent the appeal to. She wasn’t the friendliest lady! I kindly told her that we faxed it to the number they provided to me last time I called!
After getting nowhere with my insurance company, I called back my husband’s doctor. A wonderful lady named Suzie has been working on his case since this all started. She is fabulous! She has done more than any other health professional has for us. She is all but pulling her hair out trying to get this for us! I will definitely send her a card and flowers or something when this is all over. I talked to Suzie and she informed me that the doctor is in fact changing his diagnosis to Crohn’s because he is exhibiting more symptoms that lean towards Crohn’s then the U.C. And the doctor is going to prescribe a different medicine, Cimzia. This medicine is supposed to be basically the same thing just different manufacturer pretty much. Apparently the insurance companies find this one more cost efficient so they are more likely to approve it. I just think it is ridiculous that the insurance companies can override a doctor.
I did call about the assistance program that a reader had suggested. They are sending me and the doctor an application. If approved they will pay for his medicine for one year! All I can hope is one of these things get approved for us!! I just want my husband to feel healthy again!