Recently, I have had to go through some serious fighting with my insurance company for a drug that I was denied because they don't pay for it.

I am disabled and on SSI, so my insurance just based on that isn't all that great. I have problems with non-healing leg ulcers and over the years the pain management has gone beyond what I am able to handle anymore. I was in the class 3 type of pain medications and had reached the max dose on most of them. I had decided that I did not want to go to the class 4 drugs. I had my primary to refer me to a pain management clinic.

I was lucky in the fact that with the first drug that I had tried, Ultram ER, worked with one of the current pain meds that I take as a break through drug at a lower dose, on the first try. I was given samples and a prescription. I was denied having the drug filled by United Health Care.

They suggested that I take Advail or Ibruprophen as they said that it seemed to them that I hadn't tried all the other medications yet. That told me there that the insurance co. hadn't read my chart when it had to go to pre-auth. The clinic has been able to keep me supplied with the drug with the samples. The Dr. has now filed an appeal.

Now this is where I see the stupidity of this whole issue. I've had the problem with philibitius since I was 21. I am now 49. The ulcer started when I was in my 30's. The first few bouts with the ulcers were able to be resolved with wound care. Pain medication for me was an "as needed" thing. Yes, having my legs swollen because of a blood clot along with open ulcers, was very painful for me, but I would take the pain meds only when I couldn't tolerate the pain and being on bed rest wasn't working either. I do not want to become addicted to pain meds, so I was very careful about how much I took, the dose and if it seemed as if the pain was lowering on the pain level scale, I would cut back on the amount I was taking. When I reached my 40's The legs ulcers were becoming harder to heal. The ones I have now, I've had for over 6 years. Both my legs now have ulcers.

The insurance co. has had nothing but constant bills from me just in wound care. I am trying to find a find a common medium where I do not have to move into the class 4 type of drugs that not only increase my chances of addiction, but long term use will cause the insurance company to have to pay for bills for other medical problems that have been caused because of the medical side effects of long term use.

So, the insurance company thinks that they are saving themselves money by refusing to pay for a non-narcotic drug that has proven to work for me and has helped me to cut back on the dose of the narcotic that I am taking in conjunction with it. Now, is the insurance company forcing me to take the class 4 drugs or do they want me to go back to square one where I start back on a low dose of a class 3 drug and continue to increase the dose until I have maxed out on that? Been there, done that.

We haven't just become informed consumers, but harassed, stressed out, frustrated consumers. I wonder if the insurance company will be willing to pay for my nervous breakdown?

DCMerkle

    

Ha! It's funny how these things just snowball out of control while they dilly dally, trying to get out of their obligations while causing stress to us when we should be using our energy to heal.