Insurance and Red Tape

I've been doing well lately, and I'm doing well today. For that I am very thankful. But I am really tired of red tape, negligence, and insurance companies. Don't get me wrong. I'm thankful that I have insurance. Without it, I wouldn't be here. My medications and procedures have been covered without too many incidents. However, when an incident occurs, it doesn't make me happy.

It started just before the new year. I contacted my pharmacy to let them know I was almost out of Xeloda (three chemo pills are taken twice a day for a week, stop for a week, then repeat). The man with whom I spoke claimed I would have my pills by Thursday 1/5. I didn't have enough to take until that point, so I delayed the start of the cycle by a day. He called me again on 1/5 to arrange the delivery on 1/6--they wanted to ship the Xeloda with the Tykerb (five pills are taken daily). I'm sorry, but I believe my health is more important that saving shipping costs. Anyway, I was now out. It didn't arrive on 1/6 because of weather conditions everywhere but here. In the meantime, I emailed my doctor about the situation. She told me how to proceed and had ordered a new prescription of Tykerb on 1/3. I finally received the Xeloda on 1/9.

On to the Tykerb. I've been expecting my pharmacy to contact me concerning a prescription renewal and planned to contact them by Monday 1/16 if they had not contacted me. (With chemo pills, the pharmacy is not a regular pharmacy. I can't go to a neighborhood pharmacy to pick it up. It's ordered through a specialty pharmacy and then shipped to me. They generally contact me when it's time for a new shipment.) However, I received a letter from my insurance company today, stating they were unable to authorize Tykerb at this time. Their licensed clinical pharmacist reviewed my case and didn't approve it. They stated I needed to be taking Xeloda with the Tykerb before they could approve it. Excuse me? They should know I do since they're paying for a vast majority of it! 

Sorry about the rant. I am VERY appreciative of all that's been paid for by the insurance company, but I have very little tolerance for neglect at this level. Their licensed clinical pharmacist could easily have looked at my history and known that I needed this medication. Instead, they're more concerned about dotting every i and crossing every t. I'm sure that all it will take is a call from my doctor to correct the situation, but it really shouldn't have to be done. In the meantime, I'll have to cut back on the number of Tykerb I take each day so I'll have enough for the next shipment.

Let me emphasize that I have been doing MUCH better lately. I am very thankful for that. I'm going to enjoy these days. I am thankful that I have the Xeloda now and will start the next cycle tomorrow (1/15). However, Xeloda doesn't like me. It gives me more headaches, makes me more tired, and gives me stomach cramps. Please pray that it will be nice to me this time. He listens, you know. 😉