Since everyone’s insurance makes changes about this time, I have to deal with a few. I’m on a PPI for life for two medical conditions, one inherited and one developed. BCBS of MA, who is my insurance carrier granted me a lifetime approval for Prevacid 30mg QD. But this year, I get a letter. They are dropping coverage on all PPI’s except for omeprazole 20 or 40mg. So I call BCBS to see if this really applies to me. After giving them my ID number etc the conversation goes pretty much like this:
Me: So you are telling me, I have to have my doc resubmit all the information you currently have on my conditions, even though one I’ve had my entire life, in order to get another approval for Prevacid even though you have already granted me a lifetime approval for Prevaicd?
BCBS: Correct sir. We need that information.
Me: You already have that info.
BCBS: Your physician will have to resubmit it.
Me: You do realize it’s going to be the exact file you have detailing my conditions
BCBS: Yes, but we need it resubmitted to review it
Me: You already have it, can’t you open the file and look it over, or have someone from P&T or Medical Review do that
BCBS: No sir, we need it to be resubmitted
Me: Even if there are no changes
Me: You do realize that increases the cost of medical care since you already have the exact file that would be resubmitted. Isn’t it possible to save everyone some time and money and just look over the file you have. You guys have already looked over it once and given me a lifetime approval on the PA.
BCBS: Sir, we realize that, but we need the documentation resubmitted becasue coverage changed on the entire class of drugs
Me: what are my non submitting options?
BCBS: Omperazole 20 QD or 40mg QD.
Me: Are you trying to kill me? Have you read the research on Prilosec 20mg vs Prevacid 30mg? The fact that the FDA actually said Prevacid was superior to Prilosec in symptom resolution and healing rates?
Me: That I have 2 conditions, one which requires symptom resolution on a daily basis and one that required healing of an erosion. Are you trying to cause me to have pain and suffering or end up with a GI bleed?
BCBS: Sir you can have you physician submit the required documentation.
Me: You already have it
Me: Look, I’m just saying, I spent 3 years immersed in PPI’s. I know more about them then you pharmacists probably do. I’m willing to come in and teach them a thing or three. But I’m not taking a dose like prilosec 20mg when it’s a piece of shit compared to what could be considered the most effective PPI in the class based upon research of other companies that produced PPI’s and based upon TAP’s own research.
BCBS: sir we are not asking you take inferior drugs.
Me: So I can get omeprazole 40mg QD and no one has to do any extra work?
BCBS: yes sir that is correct.
Me: Why didn’t you just say so?
I’m such an ass at times! I bet they love dealing with me.
Since my ribs still hurt, I went in for X-Rays yesterday. I run and bike with my PCP, so he asked for them to be read stat! He needs to find out quickly how long I’m out of the game.
I get to the xray place and it’s packed. Apparently the Christmas holiday is the time to hurt yourself. After an hour of reading, they call me back. The first thing the nurse says to me is take off your shirt and tape these BB’s to your nipples. Well helloooo nurse, I like how you roll! Kinky! I’ve never taped BB’s to my nipples or anyone else’s for that matter. Then she says turn around I’m going to shoot you from the back. Hey! Wait. I’m not into getting shot in the back, that’s just a touch over my comfort limit. Is there a safe word I can use here? Oh you want to x-ray me from the back. Slightly embarrassing but….
Then she had me lay on a table and said she was going to tape a BB to my ribs. Sweet, back to the taping, I like it! Then she tells me it’s so the radiologist knows what side of the xray to look at. Oh, here I thought we were going to get to know each other better. My bad. After numerous x-rays, she said I could take off the BB’s and put my shirt on. Whatever. I’m keeping the BB’s on!
Since the x-rays were read stat, Mark calls me about 3 hours later and gives me 2 pieces of news. No broken ribs! But wait, I get a bonus finding. A small nodule on my L. lung. Thats right, it’s 2 for 1 finding x-ray day.