I was down to my last shot last week so I called in to Aetnas specialty pharmacy Monday to order. To my surprise the pharmacist told me that my insurance authorization for the medication had expired and my Dr. needed to resubmit a request to the insurance company before they could ship it out. However, she assured me this could be handled the same day and they could still get it out if they received it quickly. I called my Dr and spoke to her assistant. She told me they had actually faxed it over last week, but no problem! They could fax over the form again immediately.
A few hours later I called the pharmacy again to check they had received it and could ship out the meds. "No, we haven't received the form yet." After several phone conversations back and forth and in desperation, a call directly to my main insurance number, I learned the form had been received but it "didn't have all the information they needed on it and the request had been denied. However, if the Drs office would just call in they could get the information they needed over the phone and appeal the denial." By this time it was too late to get the medication out today, but they could get it out first thing the next day and I would still have it in time for Wednesday so I wouldn't miss a dose.
Wrong. The next day was Pioneer Day here in Utah so even though I had called and left a message the night before for the Drs office, they were closed Tuesday so no-one was available to call in to my insurance. I resigned myself to the fact that for the second month in a row I was indeed going to miss a dose, but I was trying not to stress over it. All I could think was... of course. It's not enough that I'm in constant pain and can barely walk. Now I'm going to lose my medication. Really, what else can go wrong this month?
Wednesday came and it was back and forth on the phone again with no resolution. I was a little bit frustrated at this point. I hadn't heard anything back from either side by the evening and we were going to go in to Thursday with absolutely no progress. Mike was stressed out of his mind. I had learned last month with the whole UPS fiasco that you can miss a couple of doses and be just fine but he wasn't acknowledging that as an acceptable answer.
Thursday I called the Drs office first thing in the morning and they told me they hadn't made any progress and were going to make some calls and would call me back. Ugh. About an hour later I got a call back from them and they told me they had talked to my nurse Brandee and she had called Jean at MS Lifelines, (she is the drug companies insurance specialist.) Jean was going to call the insurance company and get things straightened out and if needed, get me some medication to hold me over. A few hours later as I was leaving work I picked up my phone messages and there was a message from Jean that everything was approved and to call the pharmacy to get the medication shipped out. I was so relieved. I called the pharmacy immediately from my office parking lot and even though it was too late to get the shots shipped out that night for Friday delivery, they were able to arrange a special Saturday morning delivery for me so I would have the medication for the weekend.
What a stressful week! But I was SO thankful for Jean and Brandee for getting everything sorted out for me so fast. At the end of the day I only missed two shots and I would be able to restart the medication without starting over again with the titration pack, (smaller doses.) I am really grateful for people who advocate for me. While I am definitely my own advocate too, it is so nice to know I have a support system of people behind me to help me with all these things. I'm not sure why you have to get reauthorized yearly for a medication when your disease has no cure, so they know you still need it, but I now know to reach out for that authorization several weeks prior every July in case there are complications... and if there are ANY issues, I can call MS Lifelines and get help immediately.
It's been a crazy month. Can August get here already?
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