Working Around the Insurance Companies

A friend is on vacation this week, and she’s having fun, despite having to shave some of her medications every 2 or 3 days. Here’s the deal;

She has medical insurance through her former employer, the same medical insurance she had while she was working, but since she’s retired, the actual insurance company has changed. Apparently, this new company wants to ‘save’ every penny it can. No matter what the cost to the people who rely on them for help with medical bills.

My friend was diagnosed many, many years ago with chronic depression. After taking antidepressants and getting counseling for several years, she felt she had it under control and her doctor helped her wean herself from the antidepressants. She did well for over a decade.

Almost a year and a half ago, she realized the depression had snuck back into her life, and she asked her doctor to prescribe some antidepressants. There were some new ones available that he thought might be a good fit, the insurance company (at that time, the old one) had no problems approving them.

The insurance company changed, and the friend felt that particular antidepressant wasn’t working well, so her doctor changed her prescription. The insurance company threw up all sorts of road-blocks; ‘This drug is a level 2, and should not be prescribed without a clear indication this strong a drug is needed’, and who knew what else. Happily, her doctor and pharmacist argued with the insurance company on her behalf, and eventually, she got her new antidepressants.

All seemed to be going okay, although she still felt more depressed than not after several months. When she mentioned that to her doctor, he agreed to up her dose. She had just refilled her prescription based on the old dosage, and simply increased the number of pills she took each day from 2 to 3. Realizing her insurance company would need to ‘approve’ this higher dosage, she called her doctor’s office a FULL WEEK before she needed more pills so that the change could be made, and (she hoped), she would be able to refill the higher dosage without any problem.

She had to go for 3 days without any antidepressants before the insurance company finally approved the change in dosage. Once she started taking her pills again, it was a full week before she felt she could function.

When she realized she would be on vacation when it was time to refill her prescription, she cringed at the idea of fighting with the insurance company over an early refill. She would get home only 2 days AFTER she ran out of pills, but she didn’t want to go completely without for 2 days, and be unable to function for 4 or 5 days after that. So she’s been carefully skimming her dosage down to 2 pills every 3rd or 4th day, and taking the full dose of 3 pills the remaining days. On those days when she only takes 2 pills, she returns to her room a little earlier, in case some fogginess overtakes her as her drug level dips, and the following day, she may start her activities a little later, to give that drug level a chance to start raising.

She thinks she’s exercising some control, but the fact is, the insurance company has won. They have become the de facto death panels.