Monday, July 07, 2008

Playing with my webcam. It sure was a lot of fun watching my weirdos making faces. I had to keep showing Nicholas where the eye of the camera was because he kept looking at himself instead.

Look how big our Pancakes is getting! Now that we've separated them, Hyrup is finally eating. No more mating for these two lovebirds.

My children are strange. They get it from their Mother. And I just wouldn't have it any other way.

On a completely different note; I called my insurance company this morning regarding the Namenda. How interesting this is going to turn out to be. I have been referred back to my doctors office to tell them to appeal, as it is not MY responsibility but my MDs to appeal. With much needed information such as, why I need to take the drug like: what other drugs I've tried and failed, any adverse affects, etc.

So, I called the office with this information. Talked to the nurse who I normally talk to; and she basically tried to get the information she had more available (like in my file) from me. "Ok, so what have you tried?"

I have tried so so many different medications over the years, and have had either no luck or very bad reactions, and I honestly can't remember all of them. Can you? I explained this. And that she had my information. To which she replied, "Yes, but you have a two-volume file and this is a vacation week." Oh, I guess that would be my fault!
I need to say this first - when I mentioned this to Frank, he blew a gasket; but that's just Frank. Riiiight, or is it? As far as the insurance company was concerned, they weren't going to take or accept an appeal from me, just from my doctor at this point. Only his appeal will be acceptable. I can fax or mail an appeal, but they will most likely be disregarded as I am not the prescribing MD, and this medication is, you guessed it, "off-label."
I tried explaining to the kind man, and he was very kind, that there are only four drugs presently available for migraine, and well, I can't take any of them; and that they do, as my insurance company, already allow different off-label medications for me.
He insisted it wasn't so much the "off-label" practice, as it was the Namenda and the Chrysler portion of my insurance where the problem lay. hmmmmm. WHAT????
So now, I suppose I'm just to sit and wait for what exactly? Another letter of denial from the insurance company? Or a call from the office saying she has my nice condensed file all figured out and my med list updated and sent to the insurance company?
I have to say, this will be the second time my doctor's office makes an appeal. Since going down on the Namenda, and I am on my final week of every other day at 5mg. I am now getting 3 migraines per week as opposed to per month on my usual dosage. Before Namenda - they were daily. Oooh, goody, something to look forward to. Great.
Here's hoping I get reapproved.
Let's hear it for the insurance company, having more power than the doctor, who spent time and money studying in prestigous schools, to become qualified to write that script, just to have it denied when you really need it - by the almighty insurance company.
Hope you have a pain-free day

1 comment:

emily said...

sounds so frustrating. i totally hear you. here's hoping the insurance company docs see the light and approve you for the namenda soon!