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I hate changing insurance companies

Jan 07, 2015 8:56 PM

Last year my insurance for my drug plan with Medicare does not cover me very much. It seem like I was paying more for the drugs then they were. I was paying a lot for the plans. So I switch plans this year. But that is causing me a lot a lot of problems now. My arm is in horrific pain. I think it's because of the arthritis that is in it. I use lidocaine patches. So when I went to the pharmacy to get some more they said I need prior approval. I called my doctor and asked that they expedite it since I was in really bad pain and they said it would take up to 72 hours. So I have been bearing it.

So 42 hours later, They call me and say that my claim has been denied because they don't cover for arthritic pain. That is only for nerve pain. That is what I was using it for. So now I had to call the doctor again. I really hate all the red tape.

I'm using a lidocaine for these bumps on my arms. I've had them ever since I develop the arthritis on my shoulder. They're small and some are a little bit larger, but they can be very painful. It is like you don't want to move your arm at all. I just rest my arm on the armrest with a pillow below it. I'm using voice typing now when I used to type very well. And it doesn't work as good as I thought it would. I have to go back and correct it a lot. But I'm getting the hang of it. I went to the rheumatologist and he said that there was nothing he could do for my arthritis that I have all of my body. He said it was just fibromyalgia.but when I looked up about these nodules under my skin, they said that they could be related and autoimmune arthritis. I've had blood work that says it was possible I could have an autoimmune disease. And I've had blood work that shows inflammation in my blood. But the doctor says there's nothing that shows that anything is going on. I don't understand it. And it makes me very upset. I asked him what would he do if he was in my situation and he didn't know what was wrong with him. He said he would just go to the pain center. I said you would just put a Band-Aid on it. He said he we're just except that there was nothing there and that nothing to be found. But do you guys ever feel like you know your body better than they do? That you know that there is something wrong but they just can't see. I told him the only Time he will see it is on an autopsy. He made me so angry. I thought he would want better for his himself if he was in that situation. Well that is all for my ranting today. I know you must don't feel the same way at times. So I really don't have a right to complain. You all are just are the only ones I have to talk to you. Nobody else really wants to hear about it.. So I hope you don't mind. Have a good night and thanks for listening. And I hope that you are feeling as well as it's possible for you to feel. Best wishes

Jan 07, 2015 9:25 PM

Insurance red tape is very stressful. We had to change companies this year, because of constant problems last year. Just found out we, not the doctors, have to make sure everything is preapproved.

Jan 07, 2015 10:46 PM

It is extremely frustrating Profiler...I do feel that I know my body better than any doctor. I hate when a doctor says: it's 'just' fibromyalgia. I went to a neurologist that downplayed my feelings and symptoms, basically ignored what I was trying to tell him that on the last two visits I sat in my car crying for 10 minutes before driving off because of how awful he made me feel. Then I realized I didn't have to continue seeing him. Who needs that?!?!
I even went to a doctor 1+yr ago that was cash pay (an internist that practiced Eastern and Western medicine to see if someone would listen to my whole story that involves my entire body instead of just a back, a neck, an arm etc.... She did listen to me and did help me to some extent but I just couldn't afford to keep going to her after 6 months. I think that my pain specialist is the one dr I see that takes care of my whole body the best. But I still find myself wanting a dr that figures out what is going on with all of me and why.

Jan 08, 2015 12:52 AM

Sometimes I don't think doctors realize that why is more important to us than just covering it over with a Band-Aid. Yes we do need help with her pain. That is very important and I don't know what I would do without the help. But it is driving me very crazy knowing that something is wrong and they just want me to forget about it and take A pill. I know there is some good doctors out there. I just wish I knew where they were. Well you will have a good night. Best wishes.

Jan 08, 2015 9:13 AM

Profiler, it can be expensive but there are companies that do private blood tests and other tests, some even do MRI's! You pay for the test and they take you blood out whatever they need and do it. You could then use that to get your Dr to do more tests

Jan 08, 2015 9:19 AM

If you can afford it do a 'Periferal Blood Film' it's a really good test they actually look at the shape and everything of your blood cells.

After that you need to get either if you can afford it or through your Dr:

Jan 08, 2015 9:19 AM

Antinuclear antibody testsAutoantibody testsCBCComprehensive metabolic panelC-reactive protein (CRP)Erythrocyte sedimentation rate (ESR)Urinalysis

Jan 08, 2015 9:19 AM

Antinuclear antibody tests
Autoantibody tests
Comprehensive metabolic panel
C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)

Jan 08, 2015 9:23 AM

The CRP and ESR will prove inflammation the others are used to find out (well narrow down possibilities) what autoimmune disorder you have. For instance the Antinuclear antibody test, it tests for antibodies against the nuclei of your cells

Jan 12, 2015 4:54 PM

I've had the anti-nuclear blood test and it was very high at times and I've also had a metabolic test and there were things that were elevated on it. I've also had a sediment a test and it showed that the inflammation was high at times so it did show inflammation in my blood that would result in me hurting all over but I guess it had no bearing on the rheumatologist. I thought it would make a difference to him.

Jan 12, 2015 4:57 PM

On the metabolic test it was a collar comprehensive metabolic test, it showed that I was having problems with my kidneys. This could've been the result of using ibuprofen and things like that. Once I cut back on them, My kidney function return to normal. I figure with the 10 to 12 medicines that I take, my kidneys will eventually take the beating. I'm sure I'll have kidney problems in the end. It is something I'm really scared of.

Jan 13, 2015 9:42 AM

Having worked in the medical insurance industry for 11 years before I couldn't work any more, I sympathize with your plight. It's very difficult to keep up with the changing rules, etc... A good rule of thumb is about 8 weeks before open enrollment (when you can change plans or sign on for the first time), Check the meds you're on, check which company covers the majority of them and anything that needs prior authorization is taken care of between the doctor and the pharmacy. I take three meds that need authorization and they won't do it until the RX is at the pharmacy. Since the new year started, I needed all new scripts and when I got to the pharmacy, they went right through. Make phone calls to the companies, ask about how they handle special RX situations. Just like being proactive in our own care, we need to be educated on how our insurance plans work. Believe me, no matter what, you'll end up running into some red tape but the more you know of how the plans work, the less problems you will have. Hope that's helpful.

Jan 13, 2015 1:36 PM

My sister's belly hurted for a over a year

Jan 14, 2015 12:49 PM

Thanks AlwayzInpain, you are right. I really try to be proactive in my care but when it comes to my insurance, I have to admit, I have to admit, I am not careful. Last year, I didn't remember to examine my insurance before the due date. I thought I had to the fifteenth. I never figured it would be on an odd day like the 7th.

So for two years I have been paying for an expensive insurance that covers most everything but my copays are were like $10.00 and when I got my statements, I discovered that not only was I paying a large monthly fee, but according to the statement I was paying most of the medicines. The plan maybe paid $5.00 a month for my meds. I changed it this year because all my meds were on there but I have overlooked prior authorizations. I need to do it the way you do it. You are a good example. You should put that out as a reminder for people that time of year. I haven't been here then. But it is important information to know. Thanks for your help.

Jan 15, 2015 1:05 PM

Any time I can be of assistance, I'm glad to help. I will make sure when open enrollment comes around next year, I'll post a "public service announcement" to try and help my fellow pain sufferers from running into these problems. I will even put up the websites that tell you based on how you use your plan and meds you're on, which one is best for you. You should call your local social services dept and find out if you qualify for extra help in paying for your meds, co-pays and premiums. If you need any other info, I'll do my best to direct you. Hope everyone is having a good day. 💕

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