Sep 27, 2009 - 8:59 am
Let me see if I have this right.
My health insurance company has "Centers of Excellence" for just about all of life's large medical issues. Places they prefer you go to, to be treated. My surgeon and his facility fit into that category. The premise is that my Dr. is at the top of his game, is a vanguard on developing improved treatment and does so many of the procedures that the Insurance Co. feels after surgery complications will be minimal and less costly. Now this makes sense.
My Dr. obviously knows what he is doing. I left with a "Penile Rehab Plan", prescriptions for various drugs and a script for a medical grade VED, all of which are a part of the plan.
Okay, ready for it. The insurance company will gladly assist me in saving my life, but they don't want it to have any quality.
I called my pharmacy about filling the script for the Cialis. It is for 5mg tabs, to be taken once a day for 30 days and it has 12 months of refills. They told me my co-pay would be $60. Okay I can live with that. However, the insurance company will only allow for FIVE (5) pills per 30 day period. BTW it is the same for the script that I have for the Viagra 100mg pills.
I called the insurance company to discuss this. It would seem that these drugs are considered "Tier 3" drugs. Beating around the bush the representative so much as said that these drugs are considered "RECREATIONAL PHARMACEUTICALS". And don't even get me started about how the young lady laughed in my ear when I told her what a VED was.
My doctors office, as a part of the package, has also given me a letter in which they detail the plan and in bold-underlined text they use the words "medically necessary". They said that they have found it to be successful with a lot of the insurance companies if I have to go through the appeals process to get the prescription approved.
WHY THE HELL SHOULD WE HAVE TO GO THROUGH THIS?
I know that this is probably common knowledge to most of you. It wasn't to me. And I doubt if it will be to those that find us as they look for answers. It explains why there are so many posts asking about on-line drug companies and "alldaychemist".
My insurance company will pay for the shrink if I am depressed, physical therapy so I can get back on the ball field and well, you get the picture. But not to give me back the basic of man's instincts - to enjoy a good "woody". DUHH!!!
I was discussing this with my sister, who has had her own share of health and insurance issues. She relayed a story to me about a friend of hers that has been dealing with breast cancer. The friend had to have a mastectomy. When she was recovered from the surgery, the insurance company paid for the mental therapy for the depression and then paid for the reconstruction surgery, to the point where "she was at before the surgery".
That's all I am asking for. Hell I don't even need the mental work, YET!.
I plan to "Not Go Quietly Into The Night" on this one. I will attack this one on Monday. And BTW I have the young lady's name that laughed at my issues and will be talking to a supervisor about extreme sensitivity training.
So how many of you guys have run into this same scenario? Have you been successful in dealing with it? And if so, what hoops did you have to go through? And lastly, has anyone heard of this being addressed on a national level by some of the larger PCa organizations. Seems to me that this should be slid in somewhere with healthcare reform.
Looking for input on this one guys.