Thursday, July 31, 2008

Denied again

Alas, the letter I was expecting arrived today - with the word I was hoping wouldn't - "denied."

"The information provided does not meet clinical criteria for coverage of this drug." Well, bite me already. They also claim that I/we - my doctor included, as he wrote an awesome letter, "all internal appeals have been exhausted." However, IF I'm still dissatisfied with their decision, you know, because maybe I'm really OK with it! I have the right to bring a civil action - wait - I'm not exactly feeling civil at the moment.

What I am feeling, is actually impossible to describe other than beyond frustrated. How is it, that I have been on a medication that has worked for me for two years, has suddenly been forced away by "Clinical Services Department" of my insurance company??? Even though, both my Internist AND my prescribing Neurologist have sent letters stating WHY I need the medication, why it works for me. What hasn't, to be exact, in the past; which hospitals I've been admitted to in and out of state, and how many times. Not to mention the IV therapy that has been used.

So where do I go from here? Since all of my meds are "off-label" as a treatment for Migraine Disease, what makes this different? How do I make them understand the necessity for me? Am I suddenly going to slowly go downhill? Sadly, that is a question I have been avoiding to allow myself to even face. And yet, I know the reality is, I may. Afterall, my quality of life really did improve shortly after starting the medication they've decided I mustn't take.

The evil, nasty person deep inside of me; is secretly wishing mean and awful monsters on the person or persons who have made this decision on my behalf. Hey, let's be honest here, migraines totally suck. I don't want to live like I did. My kids don't deserve it; my husband doesn't - man, I don't deserve it.

Tomorrow, I see my neuro; I'm hoping he has something up his sleeve. For now; I'm up for any ideas you may have. right now, I have a migraine.



emily said...

unbelievable. i'm so sorry they've come to this (lame) decision. it makes me angry when the insurance company's doctors feel like they know more about the patient than the patient's doctor. grrr.

you've probably already read this, but here's an article that reminded me of your situation, by the incomparable Teri Robert.

i hope that something can be done -- preferably something that doesn't cost you MORE money! it just seems terribly unfair.

Migraine Chick said...

I'm so sorry to hear this. Why do they make it so hard for people like us to just get what we need.

Dr.Carley Clan said...

I am so sorry this is happening to you...they tried to do this to us ! When I was in this position we threatened legal action. that worked for us so sorry

Christy said...

I'm really sorry, Deborah. How did we end up with this crummy system? I hope your doctor can circumvent it somehow.