Don’t Toss That Paper!

Levemir and Apidra pensLast weekend, I wrote about the formulary change with my insurance company and the move of Apidra as a non-preferred drug. Yesterday, I had another issue crop up. When I first called my insurance company last Saturday, I was told that the pharmacy department would call me back about how to file an appeal to get a tiering exception and be able to get the Apidra. Later that day, the customer service person I spoke with called me back and gave me a fax number that I should fax that request to. I don’t drive so I have to ask my family to take me someplace to use a fax. I need to go that direction in another week, so figured since this change doesn’t take place until January, it could wait a week. Plus, I am looking at other plans so I want to make sure I want to stick with them before starting that process.

Yesterday morning my phone rang and it was someone from my insurance company. He said that he was with the pharmacy department and wanted to let me know that my request for a tiering exception was denied. That is funny because I did not even send that request in yet. I obviously would not expect them to just approve something because I asked for it and there was no evidence submitted as to why I need Apidra over one of the insulins that they will cover. However, that denial did change the scope of things and I now had a denial (although I have not received the paper copy yet) and am now at a different level for the request. I intend to go thru every single step of the appeal process if I have to.

I decided to put together my appeal and it would get mailed instead of faxed – that is actually easier and cheaper for me anyway. I went to pull up the 2011 formulary and discovered that Apidra was now a non-preferred drug on the 2011 formulary. They are allowed to change the formulary, but they also are required to let people know if they are taking a drug that gets changed and give you time to make arrangements for that change. I received no notice of the change.

I immediately called my insurance company. She tried to tell me that they did not change the 2011 formulary. Every year I get a paper copy of the formulary. If I want to look something up, I generally do it online because it is easier. I was sure that I had tossed the 2011 list when I was cleaning out papers because there was really no need to keep it if I was using my computer.

This morning even though I was positive that I had tossed that list, I decided to look in the spot where I would have kept it. It was there! Not only is it there, but Apidra is listed as a preferred drug for 2011 and it is now listed on their website as a non-preferred drug on the 2011 formulary. Guess someone made a boo-boo and changed something they shouldn’t have! Now I know not to toss that booklet until the end of the day on December 31st.

This morning, I am not able to log into my account because the website is down for maintenance.  They normally announce when they plan on doing that and have a notice on the site – I did not notice one yesterday.  I have to wonder if I am not the only person that called about the formulary problem and they discovered the mistake!
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2 thoughts on “Don’t Toss That Paper!

  1. I have just read your posts about your successful struggles to save your foot, and your many other frustrating dealings with the health system. I could really relate to your story, because I had very similar experiences.

    In early 2010, I was hospitalized to have my right leg amputated because of a very bad diabetic ulcer on the bottom of my right foot. I spent six days in the hospital while a steady stream of doctors came through, telling me that my leg could not be saved and needed to be amputated immediately. Ar the end of 6 days, I left without an amputation, and my leg has healed.

    A few months later, I was hospitalized again, with doctors telling me that my coronary arteries were badly blocked, and that I would die at any moment if I did not have quadruple bypasses. Once again, I left after 6 days, without bypasses, and I am having no heart symptoms, thanks largely to diet and exercise, including walking up stairs with the right leg that supposedly couldn’t be saved last year.

    How many doctors actually know what they’re doing?

    • Jim, I am glad that you still have your leg. I always tell people that say they are going to have their leg amputated to get another opinion – once that is done, there is no going back. I know if I hadn’t checked myself out of the hospital to go for my second opinion, I wouldn’t have my leg today. I think there are far more bad doctors than good – at least I have met a lot of the bad ones! But I do believe there are some really good ones out there too – I have met those too.

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