I promised terrie, but...I got it!

[gritsar]

Awhile back I ranted on the high costs of medicines and then I had to ask Terrielacy to lock the thread because some people decided to turn it into a political debate, even after I asked them not to. I promised terrie I wouldn't start another thread like that.
Right now I can't help it, because I am sitting here bawling because I am so upset and I have no one else but y'all to talk to. So apologies ahead of time to Terrie and please PLEASE don't turn my rant into a debate!
A month ago my doctor put me on a new med. for my fibromyalgia and nerve damage to my spine @ L1 and L5. I have what are called 'symptomatic intravertebral hemangiomas'.
Until I started this new med. I hadn't realized how bad the health problems were affecting my life. Suddenly after many years I was able to sleep, eat and use the bathroom normally again.
The doctor gave me samples. When the samples ran out I took the prescription to the pharmacy only to find out that my insurance company is refusing to pay for the med. The doctor filed an appeal with the insurance company.
I just heard back from the doctor's office. The appeal was turned down. The doctor is calling me in something else, but her nurse admitted that it was unlikely this other med. would help me much.
I am so upset! It's like someone telling you that you get to live normally again, but only for a short time.

We can't afford the $300+ a month that the medicine would cost if we bought it ourselves. My DH has offered to buy it for me anyhow, but I know that the money for it will be coming from something else; like his retirement fund.
The doctor's office can't help me with samples thru the drug company because I do have insurance. The drug company would help if i I didn't have insurance. Without insurance I couldn't buy my other meds. Catch 22.
This is just my rant. I'm very frustrated. Thanks for reading.

 

[jerseygirl1]

I'm sorry

I wish I could do something to help..............

 

[KellyHM]

Why is the drug company turning you down? I would get a lawyer to write them a little letter...sometimes something as simple as that will help them change their minds. Just a thought.

 

[gritsar]

Quote:
The med. costs too much. It's not like my premiums for the medicare part D doesn't cost me more than I can afford, but I guess that's different to them.

 

[sfw2]

Gritsar - I'm so sorry. It stinks that the one medication that gives you relief is beyond your financial reach.

I'm not going to say anything else, because I don't want to be the one to get your thread locked.

 

[raroo]

Aw, that sucks, I'm sorry.

I can sympathize with you. My husband has had psoriasis since he was a little boy, and it costs $130 for a tube of medication about half the size of a toothpaste tube. We can't afford it very often so he is constantly itching like crazy all over, all day long. Every other treatment (tar, zinc) is just a temporary relief. The $130 meds were actually curing it! But only if it is used every single day. Its not as serious as what you are going through, but we can definitely relate to over-priced meds that would actually make a real difference!

 

[Ol'FashionHen]

So sorry Gritsar, there are many folks that ask my Dh and I why we do not have health insurance.
Well first of all we cannot afford it, then we get told there are some affordable plans out there.
We have noticed those with the "affordable plan", wind up being charged more because they have insurance, than they would if they did not. I once worked for a chiropractor, he charged the insurance $137.00 and up for patient visit with a $30 co-pay. Folks with no insurance were charged $50.00 for all the same services period. So folks with insurance paid monthly premium plus $30, those without
$50 buck flat. It's a shame, I'll pray that somehow you can get those meds.

 

[Soccer Mom]

Don't give up hope, sweetie! Have you tried contacting the drug manufacturer directly? Sometimes they can intervene.

 

[wombat]

Sorry to hear that you're going through this.

You might want to try getting your doctor to line up a visit with a rheumatologist (or other specialist he deems appropriate), and clear that with the insurance company. Perhaps a specialist's recommendation for treatment will swing the insurance company.

My mother was suffering from a collection of symptoms, and was initially diagnosed with fibromyalgia. That's one of those odd conditions that's hard to prove or define; there's a checklist of symptoms, and if you have many of them, it might or might not be the diagnosis. Because of that, it is hard to get insurers to fund expensive treatments for it. In my mom's case, all sorts of drugs were tried, none worked for long, and she had issues with the insurance company too. Eventually my she was diagnosed with rheumatoid arthritis by a specialist about ten years ago. She had more luck getting treatment for that, and the treatment's been more effective. She also had spinal problems, and ended up having surgery to get vertebrae fused. I don't think she's had any issue with getting treatment once she was diagnosed with the arthritis, which with 10+ years of hindsight, turned out to be the accurate assessment.

Not to say you don't have fibromyalgia, but it's one of those hard to define conditions medically, and a "red flag" condition with insurers. In my mother's case, it was a mis-diagnosis. Probably worth getting a specialist's opinion. The combination of a fibromyalgia diagnosis and the spinal issues sound exactly like my mother's condition before she was found to have rheumatoid arthrits. I'm not sure how old you are, but my mother's symptoms started in her early 50s, and got progressively worse. She was not diagnosed as having arthritis until her early 60s.

My father also had to go through about a year of different doctors before he got a confirmed diagnosis. He has myasthenia gravis, but the more unusual variety in that it affected his legs first, rather than his eyes. Oddly, a fellow saw him carrying his bags through the airport, stopped him and handed him a business card indicating he was an MD, and told him that he suspected my father might have that medical condition. He told my father to have his doctor call if he had questions ... turns out the guy was a specialist in that disease. It still took my father about a year of various visits to specialists to confirm the diagnosis of the doc in the airport, but the guy was spot on, unfortunately. My father's got what is essentially a slowly progressing terminal illness, but at least now he's getting proper treatment. His doctor says that at his age, he'll go due to something else before this advances enough to be life-threatening, so it's just a matter of controlling the symtoms to improve quality of life. Anyway ... he'd had ailments for a few years before that doctor in the airport stopped him and asked him if he knew he had myasthenia gravis. His own physician had missed it repeatedly, and the first "specialist" they sent him to only tested his eyes and gave "no" on the diagnosis, even though the condition can start in the legs in rare cases.

I guess they call it "practicing medicine" because most of them don't have it down yet, and need more practice.

Anyway, I wouldn't give up on this. See if your doctor can get you approved with the insurer for assessment by a specialist, then see what the specialist recommends. If the insurer rejects the specialist's treatment plan, ask them to justify it in writing, and then take that up with your state's insurance commissioner.

 

[saddina]

I'm sorry honey

I know how it goes when meds are out of reach.