Monday, October 20, 2008

Big mess

Here it is, almost a week after Mike's doctor wanted him to start taking a new chemo... and we can't seem to get our hands on it.

We've been stuck in a maze of red tape the past several days. Try to see if you can make any sense of it:

First, we were told we couldn't get the prescription filled at Walgreen's, we had to go through the prescription service our company uses. They said they needed a "prior authorization" from the doctor. Sounds simple, right? Wrong. Doctor's office said they sent it. Prescription place said they didn't. So it went back and forth like that for a few days. Finally it gets in the right hands. Then we learn a "nurse" needed to review it. At 6:15 p.m. on Friday, I get a phone call that it's been denied. The lady said the insurance company rejected it, that they would talk to the doctor's office Monday morning to see what to do next.

Great news to get at 6:15 on a Friday, when we are powerless to do anything...

So I call the insurance company this morning to find out why this is happening. They have no clue what I'm talking about, they don't have anything to do with prescription medication, they say.

Back to the prescription service. A guy there tells me they've already sent paperwork for an appeal to the doctor, they're just waiting for a response. He tells me it could take 30 days. He tells me the info was sent to someone named Kit. There is no Kit at the doctor's office. He tells me there is. He tells me it was our employer that denied the request...

We call the doctor's office. They have no clue Mike hadn't been able to get the meds and know nothing about an appeal. They confirm there is no Kit.

Back to the prescription service. I finally get someone who puts me on hold while they call Dr. Neel's nurse. The proper paperwork is finally sent. Neel's nurse called me back later to tell me an emergency appeal was filed, basically the doctor saying this drug is a medical necessity. It will take 72 hours for a decision.

I realize this is long and rambly and makes no sense but that's what's been going on. I truly can't believe this is happening. It is beyond my comprehension that someone at an insurance company or our employer or the prescription service (I still really don't know who made the decision) can decide they know better than Mike's doctor what to do. And if we are going through this madness to get a prescription filled, I'm sure it will be a blast trying to get approval for the $11,000 chemo.

Oh, and through all this, we had Julia's Elmo party. It was quite fun and a good distraction. She was showered with so many gifts! Oh my goodness. I will post pictures of our festivities soon.

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