You have had asthma as long as you can remember–since childhood–and have been seeing the same pulmonologist for at least three years. Your doctor has had you on theophylline, a pill you take three times a day, and a Flovent inhaler (which you use twice daily) for the past year. You went to the pharmacy today and dropped off your scripts, as you do every month, only to be told you can’t fill them. Why? Because your insurance company won’t approve a prescription for more than 60 theophylline. Nor will they fill a Flovent inhaler for more uses than once daily.
Nevermind your doctor increased your doses two months ago to help you deal with the allergy season, which sends your asthma into overdrive. Nevermind your doctor wrote the prescriptions for the dosage she recommended based on your symptoms and medical history. According to your insurer, because most asthma patients in your sex and age group only take two theophylline a day and use their inhaler an average of once daily, you should be able to get by on the same doses. According to your insurer, you’re simply a hypochondriac who’s over-medicating and wasting money. So now you’re waiting for your doctor’s office and the insurance company to work it out, and in the meantime, hoping like hell you don’t have an attack because you are completely out of your medications.
Are you furious yet? I am. Because this is exactly what I am dealing with today. When I left my job, we switched to my husband’s employer-provided insurance plan, Coventry of Kansas. (Yes, I’m naming names. I only protect the innocent.) Yesterday, I submitted new, handwritten prescriptions for Bob’s four medications. Of the four, only two were filled, because he is “over their approved dose limit” for Seroquel and Focalin.
Oh, really? Take me, please, to the genius who made this decision, because I’d like to leave unmedicated Bob with them when his last Focalin wears off this evening. And tomorrow, when the school calls me to come get him, I want that person to go pick him up.
Who are these people who get to decide what medication we take and how much? Not the physicians we’re paying $100 (or more) a visit. Why bother going to a doctor at all? Next time you’re feeling poorly, just call your insurance company–they apparently have the power to diagnose you AND determine your best course of treatment, all without seeing you OR your medical history.
The good news? My husband’s employer is switching to a different carrier (the one my former employer used, in fact). If we can make it through the end of the week, I should (hopefully) be able to get Bob’s prescriptions filled as written. And happily tell Coventry of Kansas to kiss my asthma.
ED. NOTE: ConcernedMom (see comment below) agrees with the insurance company and says Bob’s psychiatrist and I over-medicating my son. Watch my response: We’re Not Trying to Drug Our Mentally Ill Kids Into Submission (Video)