Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Thursday, December 31, 2009

Anthem Sucks

So I needed more stress, right? Because the completely exhausting schedule of adding 2 hours of PT to my day 3x/week plus an hour of Dr. Mind, and this coming week an all day trip to Dr. Brain isn't enough, especially with working both last Saturday and this. And my concerns about Dr. Brain,and my weird feelings about Dr. Mind being worried enough/caring enough to come make sure I was ok after Christmas.



I think I've said on here before that I'm going to be leaving my current job for a permanent place. I need things the contract work doesn't provide, like days off and reasonable insurance. My company pays very little of our insurance costs and then we have huge deducitbles, poor coverage, and lots of hidden costs. Thus far my ankle sprain has cost me $50 for urgent care, $25 for follow-up, who knows how much for crutches and brace one, nearly $2oo for the cast boot, and $200 for my 4 PT sessions. Part of the stress right now is that I'm working my butt off to pay down debt and PT costs $150/week. And I'm looking at being in PT for a while. In fact, I'm feeling like forever would be about right. I twisted my ankle again on Monday. I had the cast boot on so it didn't twist too badly, and I managed to catch myself (bruising the outside of my hand but whatever), but it hurts more again and feels more wobbly. So we'll see if that comes off soon. And when it does, I get to buy another (cheaper) brace......



My insurance also is doing something nasty that solved the question of stay contract or go permanent; my state passed a law making insurance companies pay for mental health coverage equally to other conditions. That is supposed to mean that my therapy and psychiatrist are the same co-pay as any other drs, and psych hospitalization is the same deductible. Well, my insurance figured out a way around. They are doing the same thing as they do with PT/OT/ST: a high co-pay and then a cap per year. That wouldn't be too bad; I'd reach it probably but would manage, assuming hospitalization isn't in that cap. However, they also capped per lifetime at just 3 years of use. And that I can't live with and won't live with.

But then they've made it worse. I've talked before about my magic med, Nuvigil, which I take to help wake up and overcome the effects of the heavy sedation. It is an expensive drug, and although many bipolar people take it for the 2 reasons I do (it boosts antidepressant efficacy and helps overcome side effects of sedation), that use is off-label. Nuvigil is a newer version of an older drug, but it is cheaper than the older one because they boosted the price of the old one before it goes generic. Nuvigil also works a lot better for me; there is no overload of energy early in the day and it lasts more evenly through the day instead of just in the morning. Plus I don't have to take the max dose, and that's a good thing always when changes are constantly possible and eventually inevitable (see, why I had to go on the patch to begin with).

So the first month of Nuvigil, October, was free through a promotion. Month 2 Dr. Brain was off work so first I got a 10 day supply of Provigil for $150 out of pocket (because it was all I had a script for thanks to the hospital messing up) and then I got Dr. Body to write a script for Nuvigil. After determining nothing could be done but hope the insurance would retro-actively approve it I paid out of pocket in November. And then spent December bugging the pharmacy and Dr. Brain to work on the pre-auth.

Dr. Brain let me know last week that she'd tried to get them to skip the part that they'd automatically deny me and require her to talk to a doctor/case manager person and they gave her a hard time about it and it wasn't looking hopeful that this would happen. When I ran out of Nuvigil I took a couple Provigil, then since I knew it wasn't going to be approved in time, opted to pay for another bottle out of pocket before the tax year ended. I then emailed Dr. Brain to let her know that I was doing this and that if she heard anything to please let me know. That was when I found out she's out this whole week. She did email me back on a cc: to her secretary to ask her to check on it.

The secretary called yesterday. My med was denied. The med that lets me get out of bed and go to work may not be covered. Hopefully my doctor can fight and win. And then we'll go through it again with new insurance when I change jobs. But there is a chance I'm paying $300/month for one med for the next 3 months or so. Need I point out I do not HAVE $300, unless I pay only minimum payments on credit cards and probably charge some PT. I'm working so hard to pay off credit cards, I really do not want that.

(It should be noted I'm being negative about Anthem when it truly is THIS policy that sucks. I've had Anthem before and been quite happy with them. But oh, I'm so tired of things requiring fighting.)

Regardless, this has been enough to cause tears. Granted I'm so tired anything can make me cry, but really.......

2 comments:

Michal Ann said...

Yuk!

Emilija said...

I hope you find better insurance. I have found that all my insurance companies have found a way to cap mental health coverage.

Money troubles suck. I'm struggling too, although now I have a homecare patient and it is helping me to make it. Being sick is expensive!