Posts Tagged ‘health’

Prior authorization drills are fun.

And by “fun”, what I really mean to say is “attempts by insurance companies to gatekeep patients away from necessary medications, attempting to justify not wanting to pay to cover them”. What happens is:

· your doctor decides that you need a medication, and prescribes it
· that prescription is given to your pharmacy
· your pharmacy attempts to fill that prescription for you
· this script is presented to your insurance for coverage
· insurance denies coverage of this script
· they request that your doctor fill out forms attesting to your need for it
· your doctor has to fill out forms stating that yes, you need this medication
· these forms are sent to your insurance to approve
· if approved, your insurance authorizes your pharmacy to fill the script
· you are able to pick up your medication from the pharmacy

Basically, it’s a really snarky, underhanded, “but do you really need the medication?”.

A few medications that I take require this, and they require documentation that I have tried to take other medications and that they have not worked on me to be submitted… every twelve months.. for my insurance to continue to approve these prior authorization forms (as though these medications that I have tried in the past will suddenly, miraculously work on me one day) so that I can continue taking necessary medication…

To say “it’s a hassle” might be understatement of the year, and we are only in January. But it’s the truth.

Now that I’ve gotten all of that done…

Most of what has been needed to set this blog up has been accomplished!

Here’s hoping, at any rate.

I did the pulmonary function testing that my lung doctor needed to have on file for me this morning. When I started needing to have these done, I sucked so hard at these that they took awhile to do, pun definitely intended. But now that I’ve needed to do them with more frequency, I’ve gotten used to them, and I haven’t had to repeat any part of them… that’s always good. And when I was done with that, I got to do another six-minute walk around the area in front of my lung doctor’s office with one of the new nurses working there, which is always good for causing brief desaturations in my oxygen levels, but I mean, what isn’t these days? Luckily for me, my saturations always come back up. I don’t have some of the diagnoses that my friends have, which is always good. I count my blessings that I have asthma, and some of my friends — probably a few more of them than I realize — count their blessings that they do not have, as I’ve sometimes put it, “my level of asthma”. Ever named nebulizers? Held funerals for them as you dump them into the trash canister out front when they “die”? That’s what we’re talking about here, folks. Daria Morgendorffer humor is my thing, at least as often as I can muster it up. And that’s actually fairly frequently, because it does help out.

When you’re a “frequent flier” in the spoonie department — and a fairly young person for being a member of that department — you find that being civil and polite helps you get through the day, even though you also find that coming home and venting to your similarly minded (and bodied) friends also helps you get through your day when you have to deal with all of the bureaucratic nonsense that comes with being a card-carrying member. It does seem to surprise the people that you interface with, though. Oh, she’s actually thanking me for handing her page after page of forms to fill out? She’s actually polite about this? Yeah, I know that you’re just doing your job. I’m not going to make your life more difficult because you handed me the forms that you had to hand me. I know that you had to hand me the forms. I know that I have to fill these out. Carrying on…

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