I normally don't write much about insurance. There is a very good reason for it. I am employed by the company that insures me. It is one of the largest insurance companies in the country. So I avoid anything that might get my tushie fired. This time I can't sit by in silence. They have truly pissed me off. See I take Lyrica now. Well I did until I went to get my new script filled and found out that they wanted prior authorization for the jump in dose. I went through this one other time but that time it wasn't too bad. This time I wound up going cold turkey off the medication because I didn't know I wasn't going to have my next script. No communication from the pharmacy or the insurance company ! So that was a fun experience I really do not want to go through again. So I talked with the Dragon Lady and we got everything all set up to send in. She explained that I couldn't take Gabapentin because of an extreme side effect, namely burning muscle pain in my trapezius muscle. She also noted that since I had experienced some dizziness with it when I started she wanted to go up slowly so I could get used to the dizziness. I thought we were good to go.
That wasn't the case. The insurance company denied it as they had written it. Said they would only approve 75mg 3 times a day but it was perfectly fine to go with 150 mg 2 times a day. Take note! Praise for the Dragon Lady coming. Don't faint ! She didn't want to jump me to what would be triple my dose in 1 jump because I had gotten pretty dizzy. She was going to go to 75 for 1 month then jump to the 150. Makes perfect sense. So I called the insurance company they told me Well you should have put all that in the prior auth request and they would have approved it. I counted to 10 then asked if they could look at the prior auth request She did and said oh you did. Yep Apparently the insurance company didn't bother to read the request just denied it. She said don't worry Rightsource will fill the script they have for a partial fill for the 75 mg 3 times a day. ( They won't they have to dispense it as written. ) She also told me the insurance company would approve 100mg 3 times a day or 150 mg 2 times a day with out a prior auth request. Apparently saving money is much more important than a patient getting so dizzy they tend to fall down and possibly cause more harm. Then she said you can appeal the decision but that can take 15 to 30 days as an expedited appeal. Hmm Since I work there I know a regular appeal takes 15 to 30 days. Something sounds fishy. So I ask what should I put in the appeal since apparently my welfare is not to be considered. There was silence for a minute and then she suggested that I try Gabapentin. I explained as calmly as I could that I had experienced a bad side effect. She then said I should try it again. This is not a doctor, a nurse or any kind of healthcare worker. By now I was ready to hang up. I wanted an old style phone so I could slam it down hard. Can't do that with these new cell phones. So I just hung up. It was either that or go off on her and I couldn't hold my temper any longer.
So I sat and tried to calm down. I figured well let me try and call my nurse representative that is supposed to help me figure stuff like this out. I had called her way back at the end of March and no call back. So I called her and got her voice mail and left a message. That was Monday. Still no call and it is now Wednesday afternoon. So what do I do ? I called the PM clinic on Tuesday morning and explained to the answering service, ( Yeah one of my biggest peeves with them, can't talk to the actual office have to leave a message and get a call back.) So left a message explaining as best I could what was going on. No call yet from them.
Now I have been off the Lyrica since before the end of March. So much fun, have lost all I had gained already. Numbness and tingling is back and worse than ever. It has actually spread and I have been having so much fun falling down a lot. That is scaring me. How am I supposed to do stuff if my freaking legs don't want to work. Meanwhile at the job we are having mandatory OT. They are expecting me to bust my hump for them while they screw me over and endanger my health. I can't figure out how a freaking bean counter can over rule my doctor on what my drug dose should be. I had what I thought was a good idea. I called my local pharmacy and asked them if they knew how Lyrica 150 mg came. Was it a pill or what. Was going to have my doctor write the script for 150 mg twice a day and split the pills. Found out can't do it. They come in gelcaps only. Impossible to split. So I called Rightsource and got the information that yes the insurance company had lied to me. They couldn't fill the script as a partial fill for 90 pills. They demanded a new script. They even refused to send the last refill on my 50 mg 3 times a day script. They said that since I had presented a new script it invalidated the old ones.
So now I am boiling. I can feel my BP is rising. I hung up on the idiot from Rightsource and tried to call the nurse lady again. Still no answer except her machine and left another message. I did figure out how they are basing their decisions though. Doesn't make sense to me but apparently they will NEVER allow a script for the lower dose more times per day if it can be written as less pills in a stronger pill so 4 pills @ 75 mg is out but 3 @ 100 mg or 2 @ 150 mg is perfectly fine and they won't say a peep but they really want you to go on the 2 @ 150 mg. So apparently the patients health and well being does not matter one bit. They could care less that I would get so dizzy I would be unable to do my job for 3 odd hours while waiting for the side effects to calm down. I am betting on the 3 hour mark because that is how long the dizziness lasted on 50 mg. In fact I am betting it will be so bad I can't even get out of bed after taking it until it goes away. That sure will make trying to go to sleep after taking it fun. I can see some stumbling trips to the bathroom to throw up in my future.
So now I get to wait even longer for my medication how ever they decide to write it at PM. I can't even get it filled right away at my local pharmacy, Nope instead I have to send it in to Rightsource then wait 14 to 18 days to get the drugs. Last set they mailed out took 21 days. From Ohio to Kentucky. Makes me want to scream. This is completely freaking insane. Apparently it is 100% legal for an insurance company to deny needed meds because they cost to much and force the doctor to write the script the way they want it just to save money. The patients health and well being is not considered at all. The side effects are left to be managed by the patient even when the doctor tries to minimize them they are over ruled by the insurance company. At that strength I will have to not take my meds any time I have to drive or do anything at all that requires me to use my mind. So I guess they just fired me. Makes sense. Save some money on the drugs and then save more because they can fire me for missing time from work because I am taking the drugs they insist I take at the dose they insist I take. I think I have a solution to this. Have my doctor write it for the 2 150mg pills a day then call them in a few days and tell them I can't take them because of how dizzy I get and make them write a new script for my original dose of 50mg 3 times a day. and force the insurance company to have to fill that in same month. That will stick them with 2 bills for the same drug in 1 month because of their stupidity. Anyone have any other ideas. because I am out. I am so mad my BP was 210/156 this afternoon. An hour after I took my BP meds. That was nice. Just about drove me to the hospital from the anger and frustration of dealing with them/