Archive for the 'insurance' Category


I got a call last night. Mariella’s Pulmo has to push off her appointment AGAIN…this is the second time. The reason THIS time is that there won’t be any RT’s in the office to do PFT’s. I get that they are important, but she has been mini-flaring almost constantly for about 2 months.

I was able to call the office on a 5 minute break I had today…and she was able to squeeze us in on Friday afternoon. I don’t love afternoon appointments, but it’s what we can get. Thankfully, Rob can bring Abby to work with him for a little while.
On another note of aggravation, Rob brought Abby’s script for her new ADHD meds to the pharmacy…and for some reason, insurance doesn’t cover the generic of the 10mg capsules, it only covers the name brand. Of course, because it’s a controlled substance, the pharmacy needs a paper copy of the script…no fax allowed. At 3:30pm, there was no way that I could get to the office of the Dr. an hour away to get the script, then get it to the pharmacy. So, poor Abby went to school today without her meds…and she had a crappy day. She has been doing splendidly. I had told her that if she got a smiley face for behavior, that I would give her five dollars toward a book at the bookstore (that is big, HUGE motivation) and she just couldn’t hold it together all day. I feel so horrible…but, Rob was able to get the script today, and I’ll have it in my hot little hand for the morning, and all will be right with the world.
Looking forward to a quiet day for me tomorrow…I’ve got a ton to do, so I’m hoping for no sickies, no flares, no nothing.

Color me SHOCKED

(whatever color shocked might be)

I went to the pharmacy to get M.’s prescription yesterday. All the hoop jumping worked. The Pharmacist remarked that she has never, ever had to do all this stuff to get a script through before.

I fully expected that it was going to be a high tiered script. I play a game before I pick up new prescriptions, where as I’m walking into the pharmacy, I guess how much the script is going to be. I’m usually right.

I had to pick up a few more things, so I was expecting the final total to be well over $100. I was extremely surprised when it came to less than $30. Despite all the hoops we needed to jump through, M’s new script is a low tier, $10 script. That’s a savings of $50 a month, if the Qvar works for her.

Last night was a bad night. I’m chalking it up to the med switch, and letting her body adjust to it. She is sleeping in my room for the weekend, because we have company, and the company is sleeping in her room. I spent 10 minutes waiting and watching, trying to determine if the cough was from a drip or in her lungs. I decided that a treatment wouldn’t hurt, so I got it set up…(I had planned ahead, and had moved the machine from her room to mine, and had meds ready.) I climbed into the toddler size aerobed…and did her treatment. She was quiet the rest of the night, which confirmed that the cough was lung, rather than drip.

Hopefully, the adjustment is fast, and the new med works.

Since M was diagnosed, before age 2, she has been on
*Flovent (failed)
*advair (failed)
*Atrovent (seems somewhat effective)
*Symbicort (seems somewhat effective)
*Pulmocort (only when she is sick)
*Albuterol neb (rescue)
*Xopenex (rescue inhaler)
and now, Qvar (yet to be determined)

The last time we were at the pulmonologist, he asked how often we used either the rescue inhaler or neb machine. He wasn’t so thrilled when I said “we’re doing really good lately. She doesn’t need rescue more than 4 times a week. Apparently, she is not supposed to need a rescue at all. Go figure…I really HAD thought that an average of 4 times a week was good. Perhaps, eventually, we’ll get her under complete control…until then, we’ll keep trying until we do.

This is how it’s SUPPOSED to work…..

Doctor calls in prescription…pharmacy fills prescription…I pay outrageous co-pay for prescription, and go home….in a perfect world…that is how it would work.

In MY world…the past FEW times I’ve gone to the pharmacy to pick up M’s prescriptions…THIS is how it goes…

Doctor calls in prescription…pharmacy DOES NOT fill prescription…because insurance company refuses to pay for prescription without pharmacist and doctor jumping through all sorts of obnoxious hoops…I leave without prescription, with my fingers crossed that said hoop jumping works, and I will be able to pick the prescription up the next day.

I don’t know how to make this easier. I guess having a healthy child would make it easier. I should be thankful that we HAVE prescription coverage at all…but really…we pay for coverage. All the medications we need should be covered by the insurance that we pay for.

Ah, well…this is where I throw in my catch all catch phrase…”it is what it is”