Thirteen days into the new year and already I've spent a disproportional amount of 2013 figuring out how to appeal my insurance provider's decision to deny coverage for the medication I've been taking for the past nine years. I received a letter notifying me of their decision last week. My stomach has been in knots ever since and I've been plagued by incessant dread.and a sense of impending doom.
This is not just me being melodramatic. There is a lot at stake here and the potential consequences for me are huge. The medication will end up costing me about $325 a month if I can't convince the insurance to continue paying for it. Yet not taking the medication isn't an option either, unless my doctor can come up with something that works just as well. I don't hold out a lot of hope for that though; we tried probably five different medications before trying the medication I take now. None of the other ones worked.
So I find myself in a situation that seems hopeless to me. It appears that the only way to prevent a significant setback in my life - probably a financial one, since not taking medication would pose a serious risk to my health - is to convince the insurance company to pay for my medication. I am, of course, going to focus all of my energy on building a persuasive argument. My interactions thus far with the insurance company, however, have not been encouraging. I spent the whole of last week trying to get information from them. They say I should receive something in the mail, but I've yet to get anything.
Even my doctor seems to have abandoned me. I called her office last Monday morning...and Tuesday and Wednesday and twice on Thursday...and nobody ever called me back, not even when I said it was urgent. On Friday, I went to the office in person to find out what was going on. There, the staff members at the front desk were extremely rude. I was told that my doctor can't help me and that it's my responsibility to deal with the insurance company...As a [mental] health professional myself, I know that the doctor does, in fact, have if not a legal then an ethical obligation to help me with this situation. The insurance company wants to know why the doctor considers my medication to be "medically necessary." Obviously, the doctor is the best person to explain this.
I left my doctor's office on Friday feeling depressed and defeated. I took the weekend off from worrying, but I'll be back at it again tomorrow. I've scheduled an appointment with my doctor; it will no longer be possible for her to ignore me. I had hoped she would be an advocate for me; I feel like I could really use one right about now.