Question:
I have my doc appointment on Tuesday providing my insurance gets it’s shit straightened out. I requested several referrals over a month ago, one of them TWO months ago, when I went in for an office visit about my moles and the doc wanted me to see a dermatologist to have them analyzed. Anyhow, I called the office AGAIN today (this is about the 15th call, and about 10 faxes) and they told me that the insurance denied EVERY ONE OF THE REFERRALS! I couldn’t BELIEVE IT! I have some serious problems going on, and they deny the referrals that a DOCTOR ordered? Anyhow, then I called the insurance, and they said that they have no record of anything being denied, and that all the doc’s office needs to do is call them and tell them what I need (they have been faxing, but I guess that didn’t work too well). What I was pissed off at was the fact that I have called there over a dozen times, left my name and phone number because the referral coordinator was busy, and NOONE CALLED ME BACK! Even when I told them that no one has been calling me back, STILL, no one called. I was so pissed. I have this appointment on Tuesday that I NEED to go to (I am having severe problems with shaking and tremors…I was put on a med that seemed to work, but doesn’t anymore. Also, I am severely Hyperthyroid, and have other things going on. Not to mention that my Rheumatologist does my pain management), and I cant afford to pay the $50 if I don’t have a referral. I am just so pissed at my doctors office…I mean, I put in for those referrals 5-6 weeks ago, and the other one for the Dermatologist 2 MONTHS ago (my office visit was May 15th and that’s when he ordered the referral for the Dermatologist). Why didn’t ANYONE call me and tell me that there was a problem? Instead, I sent faxes, and called, and no one ever called me back to let me know what was going on. Then I call the insurance to find out that they have no record of any denials? WTF is going on? I told Rich that if something happens to me, to sue both the doctor’s office for negligence and the insurance company as well since they take FOREVER to issue referrals…I could freakin’ die of a heart attack because they didn’t authorize the cardiologist referral in a timely manner. Most referrals are ready within 72 hours, and look how long I have been waiting. It’s because they have to get authorization from the insurance company, but still, it should NOT take WEEKS! I have also had to fight them for medications that they don’t cover. One month they covered one of my meds, and the next month they didn’t. At my last Rheumy visit, he wrote a prescription for Toprol XL (and extended release beta-blocker, to slow my heartbeat down and help with the shaking). Well, I was waiting at the pharmacy, and the stupid insurance company wouldn’t cover it because it’s a long acting medication! I ended up having to get the regular release of the med. Also, they didn’t want to cover my Arthrotec (a med for inflammation), and after a battle with them, they authorized it. And, I had the same problem with my Prilosec…they wanted me to try OTC Zantac or Pepcid AC! I have tried them all, and I have severe reflux disease with erosion of the esophagus, so bad that I have to take the Prilosec twice a day, instead of the usual once a day (there is a new medicine that can help the erosion called Nexium, but I KNOW my insurance won’t cover it) Of course, they balked at my having to take the Prilosec twice a day, and at times, three times a day, and wanted a letter from my doctor stating WHY I needed the medication, and why I needed to take it more than once a day. I get so mad at this…my doc writes a prescription…that to me is authorization enough. I just worry that they aren’t going to cover my pain patches…it seems that when something I get is too expensive in their eyes (and the patches are about $600-$700 for 15 of them), they remove it from their formulary. I don’t want to have to fight for that. I just cant believe this crap about the referrals. It seems that no one knows what’s going on, and they aren’t even TRYING to figure it out! I am seriously ill and it seems these people don’t give a crap. Don’t get me wrong, I LOVE my primary care doctor, but it’s the STAFF the bugs the shit out of me. I need my Rheumy referral by Tuesday (this happened last time too..they faxed me the referral the morning of my appointment). I make sure to call in the referrals WELL before I need them (like if I have 1 visit left on a referral, I will call in for another one…plus, this STUPID insurance only gives 2 visits at a time, and the docs office has to fax them to get authorization. With my last insurance, the referral coordinator just wrote out the referral and that was it). The thing is, I cant even EAT solid food now because of the strictures on my esophagus. It needs to be dilated, but when I told this to the last GI doctor I was sent to, (my other one wasn’t covered under the new plan) he wanted a barium swallow, even though I told him that I need my esophagus dilated and biopsied every year. I told him I cannot tolerate barium and that I would not be able to swallow it without getting sick. I even told him to go talk to my former GI doctor across the hall, and to talk to the GI doctor I had before that (whom I loved, but he isn’t covered either). What is the point of doing a barium swallow when an Endoscopy will need to be done anyway? I mean, I also have erosive gastritis, where my stomach lining literally bleeds (I have the Endoscopy pic if anyone wants to see…LOL) and that cant be shown with a barium swallow. I KNOW what needs to be done, and I am NOT doing a barium swallow. So, I requested a referral to a new GI doctor, 6 weeks ago, and haven’t gotten the referral yet. Meanwhile, I am losing weight like crazy (I am just a bit overweight..had gained 70lbs due to an endocrine problem, and have lost almost 50 of that in 7 months. My clothes are falling off of me, and people are commenting now). I am so pissed with this insurance…they are supposed to be working FOR me, not AGAINST me. Same thing with my primary care doc’s office. I am tired of doing the legwork, calling the insurance, then calling the doctor’s office again to tell them what the insurance said. All I know is that if they DID deny ALL those referrals, I am getting a lawyer. I am sick of this crap. I NEED to see my cardiologist..my heart is even more erratic, and I get chest pains. I could drop dead of a freakin’ heart attack, all because the damn referral either was denied or not ready. I don’t get it. I am so stressed about this. I can’t afford to pay $50 if the referral for my Rheumy doesn’t come through…I don’t even HAVE $50! I need my meds and I need to talk to him about the increase in tremors, chest pain (pleurisy), and other things. And stress isn’t good for someone with my medical conditions. Shit, it isn’t good for anyone! Anyhow, I did call a woman that works for the insurance…she helped me before to find a reproductive endocrinologist for my mysterious endocrine problems, and then helped me again to change the date on that referral as it was going to expire before my appointment (that’s another thing…the referrals usually only have a 2-3 month time span in which it is valid. If an appointment runs past that date, then I have to get another referral, and they only authorize 2 visits at a time, meaning that every other month, I need a NEW referral to see my Rheumy. The other insurance I had issued them for 12 visits or one year. Unfortunately, I had to change insurance companies because the one I had wasn’t serving this county anymore). So, I hope that the woman I called can help me get this mess straighten out. I did have a case worker at one time, but she wasn’t any help…all she wanted to do was question me about my medical conditions, my meds, and she also wanted to talk to my doctors about why I was on certain meds. When I found this out, I faxed all my doctors letters stating NOT to give ANY of my medical information out to this woman. She wasn’t helping in the way I needed, she was just nosey. OK, I am done rambling. I have to go lay down. I didn’t type this all at once, some of it is pasted for an email, but only the beginning. Sorry about that guys, but I just cant sit here. But then again, I cant sleep because of the pain. Crap, I need a laptop (out of the question though! LOL) Hugs to all, and hopes for a pain free day tomorrow Nikki "… lost in the darkness of my own circumstance, criticizing echoes leaving me awake in the night… the barrier and blockades that keep me safe and in control while I pretend that I am okay… "
Response:
Nikki I just wanted to speak to you about the barium swallow. I also have strictures of the oesophagus & oesophagitis. I had a nissen fundoplication years ago to stop the reflux & it did work for a while but I think the wrap is getting a little ‘loose’ now as I am now able to vomit easily & the reflux is back…..I’m undecided whether I’ll let them redo the wrap. Anyway my gastro would NEVER order barium for me. They use gastrograffin on me which is actually water soluble & where barium is supposed to constipate you gastrograffin works the opposite way. Gastrograffin is quite expensive but maybe you could ask for that… Also I have had perforated intestines more than once & barium is contra-indicated if they think there is the chance of a perforation. My gastro always orders a swallow before the endo & he does this to get an idea what shape my oesophagus is in. I’m lucky cos I can have the gastrograffin swallow, drain it out my Gtube & then go for my endo an hour or so later. Also my gastro has told me that some people can have strictures & they are asymptomatic….I guess by doing the swallow first they can see just how much of a problem the strictures are. Anyway like I said, if you are worried about the barium see if you could get the gastrograffin. It isn’t a nice taste at all (well I don’t think it is) but it is the consistency of water so should be much easier to go down. Son
Response:
Nikki I’m so sorry you are having such crappy luck with your insurance. Have you tried calling Member Services? Member Services should get all your referrals done right away. As for Nexium, your insurance may pay for it since it’s the generic for Prilosec. Prilosec’s patent is up and they’ve come out with Nexium. I take Protonix (a proton pump inhibitor like Prisolec) and it’s cheaper than Prilosec. There’s also Prevacid (another PPI). I take the Protonix and 300 mg Zantac a day. Good luck fighting with the insurance!!! Start filing complaints! Nicole
Response:
And, I had the same problem with my Prilosec…they wanted me to try OTC Zantac or Pepcid AC! I have tried them all, and I have severe reflux disease with erosion of the esophagus, so bad that I have to take the Prilosec twice a day, instead of the usual once a day (there is a new medicine that can help the erosion called Nexium, but I KNOW my insurance won’t cover it)
Nikki, I can’t help you with the other stuff, but don’t waste any time trying to get Nexium. It’s only chemically slightly different than Prilosec and does no better job of treating esophageal erosion than Prilosec does. The deal is, the patent is about to come off of Prilosec and generics will come out. So the mfr. changed an isomer, thought up a new name, and put three gold stripes on the same purple pill. Voila! New patent, new license to print money. Best, mary
Response:
You probably already know,but just in case,Your hyperthyroid can cause a lot of your symptoms.Like shaking ,tremors,irregular heart beats,chest pains,weight loss,and no telling what else.My wife had all of these symptoms,and after she got the thyriod level down,they went away. IMHO that is the first thing you need to get under control,because the thyriod harmone (sp) is very strong,and can really mess you up all over. Just FYI,I hope this helps. Good Luck Lem – Hide quoted text — Show quoted text -I have my doc appointment on Tuesday providing my insurance gets it’s shit straightened out. I requested several referrals over a month ago, one of them TWO months ago, when I went in for an office visit about my moles and the doc wanted me to see a dermatologist to have them analyzed. Anyhow, I called the office AGAIN today (this is about the 15th call, and about 10 faxes) and they told me that the insurance denied EVERY ONE OF THE REFERRALS! I couldn’t BELIEVE IT! I have some serious problems going on, and they deny the referrals that a DOCTOR ordered? Anyhow, then I called the insurance, and they said that they have no record of anything being denied, and that all the doc’s office needs to do is call them and tell them what I need (they have been faxing, but I guess that didn’t work too well). What I was pissed off at was the fact that I have called there over a dozen times, left my name and phone number because the referral coordinator was busy, and NOONE CALLED ME BACK! Even when I told them that no one has been calling me back, STILL, no one called. I was so pissed. I have this appointment on Tuesday that I NEED to go to (I am having severe problems with shaking and tremors…I was put on a med that seemed to work, but doesn’t anymore. Also, I am severely Hyperthyroid, and have other things going on. Not to mention that my Rheumatologist does my pain management), and I cant afford to pay the $50 if I don’t have a referral. I am just so pissed at my doctors office…I mean, I put in for those referrals 5-6 weeks ago, and the other one for the Dermatologist 2 MONTHS ago (my office visit was May 15th and that’s when he ordered the referral for the Dermatologist). Why didn’t ANYONE call me and tell me that there was a problem? Instead, I sent faxes, and called, and no one ever called me back to let me know what was going on. Then I call the insurance to find out that they have no record of any denials? WTF is going on? I told Rich that if something happens to me, to sue both the doctor’s office for negligence and the insurance company as well since they take FOREVER to issue referrals…I could freakin’ die of a heart attack because they didn’t authorize the cardiologist referral in a timely manner. Most referrals are ready within 72 hours, and look how long I have been waiting. It’s because they have to get authorization from the insurance company, but still, it should NOT take WEEKS! I have also had to fight them for medications that they don’t cover. One month they covered one of my meds, and the next month they didn’t. At my last Rheumy visit, he wrote a prescription for Toprol XL (and extended release beta-blocker, to slow my heartbeat down and help with the shaking). Well, I was waiting at the pharmacy, and the stupid insurance company wouldn’t cover it because it’s a long acting medication! I ended up having to get the regular release of the med. Also, they didn’t want to cover my Arthrotec (a med for inflammation), and after a battle with them, they authorized it. And, I had the same problem with my Prilosec…they wanted me to try OTC Zantac or Pepcid AC! I have tried them all, and I have severe reflux disease with erosion of the esophagus, so bad that I have to take the Prilosec twice a day, instead of the usual once a day (there is a new medicine that can help the erosion called Nexium, but I KNOW my insurance won’t cover it) Of course, they balked at my having to take the Prilosec twice a day, and at times, three times a day, and wanted a letter from my doctor stating WHY I needed the medication, and why I needed to take it more than once a day. I get so mad at this…my doc writes a prescription…that to me is authorization enough. I just worry that they aren’t going to cover my pain patches…it seems that when something I get is too expensive in their eyes (and the patches are about $600-$700 for 15 of them), they remove it from their formulary. I don’t want to have to fight for that. I just cant believe this crap about the referrals. It seems that no one knows what’s going on, and they aren’t even TRYING to figure it out! I am seriously ill and it seems these people don’t give a crap. Don’t get me wrong, I LOVE my primary care doctor, but it’s the STAFF the bugs the shit out of me. I need my Rheumy referral by Tuesday (this happened last time too..they faxed me the referral the morning of my appointment). I make sure to call in the referrals WELL before I need them (like if I have 1 visit left on a referral, I will call in for another one…plus, this STUPID insurance only gives 2 visits at a time, and the docs office has to fax them to get authorization. With my last insurance, the referral coordinator just wrote out the referral and that was it). The thing is, I cant even EAT solid food now because of the strictures on my esophagus. It needs to be dilated, but when I told this to the last GI doctor I was sent to, (my other one wasn’t covered under the new plan) he wanted a barium swallow, even though I told him that I need my esophagus dilated and biopsied every year. I told him I cannot tolerate barium and that I would not be able to swallow it without getting sick. I even told him to go talk to my former GI doctor across the hall, and to talk to the GI doctor I had before that (whom I loved, but he isn’t covered either). What is the point of doing a barium swallow when an Endoscopy will need to be done anyway? I mean, I also have erosive gastritis, where my stomach lining literally bleeds (I have the Endoscopy pic if anyone wants to see…LOL) and that cant be shown with a barium swallow. I KNOW what needs to be done, and I am NOT doing a barium swallow. So, I requested a referral to a new GI doctor, 6 weeks ago, and haven’t gotten the referral yet. Meanwhile, I am losing weight like crazy (I am just a bit overweight..had gained 70lbs due to an endocrine problem, and have lost almost 50 of that in 7 months. My clothes are falling off of me, and people are commenting now). I am so pissed with this insurance…they are supposed to be working FOR me, not AGAINST me. Same thing with my primary care doc’s office. I am tired of doing the legwork, calling the insurance, then calling the doctor’s office again to tell them what the insurance said. All I know is that if they DID deny ALL those referrals, I am getting a lawyer. I am sick of this crap. I NEED to see my cardiologist..my heart is even more erratic, and I get chest pains. I could drop dead of a freakin’ heart attack, all because the damn referral either was denied or not ready. I don’t get it. I am so stressed about this. I can’t afford to pay $50 if the referral for my Rheumy doesn’t come through…I don’t even HAVE $50! I need my meds and I need to talk to him about the increase in tremors, chest pain (pleurisy), and other things. And stress isn’t good for someone with my medical conditions. Shit, it isn’t good for anyone! Anyhow, I did call a woman that works for the insurance…she helped me before to find a reproductive endocrinologist for my mysterious endocrine problems, and then helped me again to change the date on that referral as it was going to expire before my appointment (that’s another thing…the referrals usually only have a 2-3 month time span in which it is valid. If an appointment runs past that date, then I have to get another referral, and they only authorize 2 visits at a time, meaning that every other month, I need a NEW referral to see my Rheumy. The other insurance I had issued them for 12 visits or one year. Unfortunately, I had to change insurance companies because the one I had wasn’t serving this county anymore). So, I hope that the woman I called can help me get this mess straighten out. I did have a case worker at one time, but she wasn’t any help…all she wanted to do was question me about my medical conditions, my meds, and she also wanted to talk to my doctors about why I was on certain meds. When I found this out, I faxed all my doctors letters stating NOT to give ANY of my medical information out to this woman. She wasn’t helping in the way I needed, she was just nosey. OK, I am done rambling. I have to go lay down. I didn’t type this all at once, some of it is pasted for an email, but only the beginning. Sorry about that guys, but I just cant sit here. But then again, I cant sleep because of the pain. Crap, I need a laptop (out of the question though! LOL) Hugs to all, and hopes for a pain free day tomorrow Nikki "… lost in the darkness of my own circumstance, criticizing echoes leaving me awake in the night… the barrier and blockades that keep me safe and in control while I pretend that I am okay… "
Response:
Nicole, Nexium is not the generic for Prilosec. It is stronger than Prilosec. Prilosec is 20mg per dose and Nexium is 40mg per dose. Prilosec can be taken once or twice daily and Nexium is taken once daily. My Dr. just started me on Nexium. I find Prevacid works much better for me. Robin Path: lobby!newstf02.news.aol.com!portc01.blue.aol.com!news.maxwell.syr.edu!net
news.com!xfer02.netnews.com!newsfeed2.earthlink.net!newsfeed.earthlink.net !newsmaster1.prod.itd.earthlink.net!newsread1.prod.itd.earthlink.net.POSTE D!not-for-mail – Hide quoted text — Show quoted text – Newsgroups: alt.support.chronic-pain Lines: 16 X-Priority: 3 X-MSMail-Priority: Normal X-Newsreader: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 NNTP-Posting-Host: 63.49.236.64 X-Trace: newsread1.prod.itd.earthlink.net 995149105 63.49.236.64 (Sat, 14 Jul 2001 15:18:25 PDT) Organization: EarthLink Inc. — http://www.EarthLink.net (newsmaster1.prod.itd.earthlink.net) Nikki I’m so sorry you are having such crappy luck with your insurance. Have you tried calling Member Services? Member Services should get all your referrals done right away. As for Nexium, your insurance may pay for it since it’s the generic for Prilosec. Prilosec’s patent is up and they’ve come out with Nexium. I take Protonix (a proton pump inhibitor like Prisolec) and it’s cheaper than Prilosec. There’s also Prevacid (another PPI). I take the Protonix and 300 mg Zantac a day. Good luck fighting with the insurance!!! Start filing complaints! Nicole
I am *not* a Medical Doctor (MD) or *any* other type of Medical Professional. PLEASE consult your own Dr. for medical advice. The information posted is information I have learned from researching or learning from my own disease.
Response:
– Hide quoted text — Show quoted text – And, I had the same problem with my Prilosec…they wanted me to try OTC Zantac or Pepcid AC! I have tried them all, and I have severe reflux disease with erosion of the esophagus, so bad that I have to take the Prilosec twice a day, instead of the usual once a day (there is a new medicine that can help the erosion called Nexium, but I KNOW my insurance won’t cover it) Nikki, I can’t help you with the other stuff, but don’t waste any time trying to get Nexium. It’s only chemically slightly different than Prilosec and does no better job of treating esophageal erosion than Prilosec does. The deal is, the patent is about to come off of Prilosec and generics will come out. So the mfr. changed an isomer, thought up a new name, and put three gold stripes on the same purple pill. Voila! New patent, new license to print money. Best, mary
BINGO Mary! You nailed that one down hard!!! Hope you are feeling better, how is the leg? Give Rick a hug from me just for being so good to you. Don’t tell him what it’s for or who it’s from just to keep ‘em guessing! Take Care, Deanie
Response:
The pharmacist on the sci.med.pharmacy said nexium and prilosec were basically the same.
– Hide quoted text — Show quoted text – Nicole, Nexium is not the generic for Prilosec. It is stronger than Prilosec. Prilosec is 20mg per dose and Nexium is 40mg per dose. Prilosec can be taken once or twice daily and Nexium is taken once daily. My Dr. just started me on Nexium. I find Prevacid works much better for me. Robin Path: lobby!newstf02.news.aol.com!portc01.blue.aol.com!news.maxwell.syr.edu!net news.com!xfer02.netnews.com!newsfeed2.earthlink.net!newsfeed.earthlink.net !newsmaster1.prod.itd.earthlink.net!newsread1.prod.itd.earthlink.net.POSTE D!not-for-mail Newsgroups: alt.support.chronic-pain Lines: 16 X-Priority: 3 X-MSMail-Priority: Normal X-Newsreader: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 NNTP-Posting-Host: 63.49.236.64 X-Trace: newsread1.prod.itd.earthlink.net 995149105 63.49.236.64 (Sat, 14 Jul 2001 15:18:25 PDT) Organization: EarthLink Inc. — http://www.EarthLink.net (newsmaster1.prod.itd.earthlink.net) Nikki I’m so sorry you are having such crappy luck with your insurance. Have you tried calling Member Services? Member Services should get all your referrals done right away. As for Nexium, your insurance may pay for it since it’s the generic for Prilosec. Prilosec’s patent is up and they’ve come out with Nexium. I take Protonix (a proton pump inhibitor like Prisolec) and it’s cheaper than Prilosec. There’s also Prevacid (another PPI). I take the Protonix and 300 mg Zantac a day. Good luck fighting with the insurance!!! Start filing complaints! Nicole I am *not* a Medical Doctor (MD) or *any* other type of Medical Professional. PLEASE consult your own Dr. for medical advice. The information posted is information I have learned from researching or learning from my own disease.
Response:
Here’s one of the post explaining the difference. I may be wrong that Nexium is the generic for Prilosec but it is made my the same company- AstraZeneca and supposedly for the same thing. Does anyone konw the difference between Nexium and Prilosec? I couldn’t figure out the difference (except they have slightly differernt chemical names. Both seem to be time released proton pump inhibotors. I’m not sure what the advantages are of each. This concerns a family member, so any reply (by mail would be best) would be appreciated. Jacob,
Off the top of my head, Nexium is a d-isomer of omeprazole (drug in Prilosec). Think of it this way, looking at your right hand and left hand. Both are hands with the same number of fingers, just oriented differently, i.e. right vs. left mirror images. The same is true of many drugs. Usually one isomer is more potent, but in lot of cases, the drug in your medication is a mixture, called racemic containing d and l isomers. I think the l-isomers are in general more important in living systems, but there are exceptions to the rule. In the case of Nexium, it is my belief that the company, made the change to extend its patient protection for the parent drug, omeprazole. Effectively, both drugs are excellent proton (acid) pump inhibitors, and useful for treatment of gastric reflux and GI injury. I think your best option is getting the one with the lowest cost, most likely Prilosec. The price of Prilosec will plummet when a generic comes out. Hope this is helpful..Bob Altic, PharmD Nexium is not the generic for Prilosec. It is stronger than Prilosec. Prilosec is 20mg per dose and Nexium is 40mg per dose.
There are 20mg capsules available for Nexium. Prilosec can be taken once or twice daily and Nexium is taken once
daily. My once a day pills never work for 24 hrs. Nicole
Response:
Nikki – unless you are recording your phone calls, DON’T USE THE PHONE! Insurance companies always either screw up or out and out lie about receiving calls and faxes. I always fax and follow up with certified return receipt mail. When I do call, I record the call (with permission of the insurance company, of course). Half the time, they refuse permission, and I give up on the call. The other half I record the call with times and dates, and always make sure I record the date, time and the name of the person I spoke with. I’m really sorry you’re having the problems with Insurance and referrals. Having been down that road so many times, I certainly understand what you’re going through. Best of luck, Rob
– Hide quoted text — Show quoted text – I have my doc appointment on Tuesday providing my insurance gets it’s shit straightened out. I requested several referrals over a month ago, one of them TWO months ago, when I went in for an office visit about my moles and the doc wanted me to see a dermatologist to have them analyzed. Anyhow, I called the office AGAIN today (this is about the 15th call, and about 10 faxes) and they told me that the insurance denied EVERY ONE OF THE REFERRALS! I couldn’t BELIEVE IT! I have some serious problems going on, and they deny the referrals that a DOCTOR ordered? Anyhow, then I called the insurance, and they said that they have no record of anything being denied, and that all the doc’s office needs to do is call them and tell them what I need (they have been faxing, but I guess that didn’t work too well). What I was pissed off at was the fact that I have called there over a dozen times, left my name and phone number because the referral coordinator was busy, and NOONE CALLED ME BACK! Even when I told them that no one has been calling me back, STILL, no one called. I was so pissed. I have this appointment on Tuesday that I NEED to go to (I am having severe problems with shaking and tremors…I was put on a med that seemed to work, but doesn’t anymore. Also, I am severely Hyperthyroid, and have other things going on. Not to mention that my Rheumatologist does my pain management), and I cant afford to pay the $50 if I don’t have a referral. I am just so pissed at my doctors office…I mean, I put in for those referrals 5-6 weeks ago, and the other one for the Dermatologist 2 MONTHS ago (my office visit was May 15th and that’s when he ordered the referral for the Dermatologist). Why didn’t ANYONE call me and tell me that there was a problem? Instead, I sent faxes, and called, and no one ever called me back to let me know what was going on. Then I call the insurance to find out that they have no record of any denials? WTF is going on? I told Rich that if something happens to me, to sue both the doctor’s office for negligence and the insurance company as well since they take FOREVER to issue referrals…I could freakin’ die of a heart attack because they didn’t authorize the cardiologist referral in a timely manner. Most referrals are ready within 72 hours, and look how long I have been waiting. It’s because they have to get authorization from the insurance company, but still, it should NOT take WEEKS! I have also had to fight them for medications that they don’t cover. One month they covered one of my meds, and the next month they didn’t. At my last Rheumy visit, he wrote a prescription for Toprol XL (and extended release beta-blocker, to slow my heartbeat down and help with the shaking). Well, I was waiting at the pharmacy, and the stupid insurance company wouldn’t cover it because it’s a long acting medication! I ended up having to get the regular release of the med. Also, they didn’t want to cover my Arthrotec (a med for inflammation), and after a battle with them, they authorized it. And, I had the same problem with my Prilosec…they wanted me to try OTC Zantac or Pepcid AC! I have tried them all, and I have severe reflux disease with erosion of the esophagus, so bad that I have to take the Prilosec twice a day, instead of the usual once a day (there is a new medicine that can help the erosion called Nexium, but I KNOW my insurance won’t cover it) Of course, they balked at my having to take the Prilosec twice a day, and at times, three times a day, and wanted a letter from my doctor stating WHY I needed the medication, and why I needed to take it more than once a day. I get so mad at this…my doc writes a
prescription…that to – Hide quoted text — Show quoted text – me is authorization enough. I just worry that they aren’t going to cover my pain patches…it seems that when something I get is too expensive in their eyes (and the patches are about $600-$700 for 15 of them), they remove it from their formulary. I don’t want to have to fight for that. I just cant believe this crap about the referrals. It seems that no one knows what’s going on, and they aren’t even TRYING to figure it out! I am seriously ill and it seems these people don’t give a crap. Don’t get me wrong, I LOVE my primary care doctor, but it’s the STAFF the bugs the shit out of me. I need my Rheumy referral by Tuesday (this happened last time too..they faxed me the referral the morning of my appointment). I make sure to call in the referrals WELL before I need them (like if I have 1 visit left on a referral, I will call in for another one…plus, this STUPID insurance only gives 2 visits at a time, and the docs office has to fax them to get authorization. With my last insurance, the referral coordinator just wrote out the referral and that was it). The thing is, I cant even EAT solid food now because of the strictures on my esophagus. It needs to be dilated, but when I told this to the last GI doctor I was sent to, (my other one wasn’t covered under the new plan) he wanted a barium swallow, even though I told him that I need my esophagus dilated and biopsied every year. I told him I cannot tolerate barium and that I would not be able to swallow it without getting sick. I even told him to go talk to my former GI doctor across the hall, and to talk to the GI doctor I had before that (whom I loved, but he isn’t covered either). What is the point of doing a barium swallow when an Endoscopy will need to be done anyway? I mean, I also have erosive gastritis, where my stomach lining literally bleeds (I have the Endoscopy pic if anyone wants to see…LOL) and that cant be shown with a barium swallow. I KNOW what needs to be done, and I am NOT doing a barium swallow. So, I requested a referral to a new GI doctor, 6 weeks ago, and haven’t gotten the referral yet. Meanwhile, I am losing weight like crazy (I am just a bit overweight..had gained 70lbs due to an endocrine problem, and have lost almost 50 of that in 7 months. My clothes are falling off of me, and people are commenting now). I am so pissed with this insurance…they are supposed to be working FOR me, not AGAINST me. Same thing with my primary care doc’s office. I am tired of doing the legwork, calling the insurance, then calling the doctor’s office again to tell them what the insurance said. All I know is that if they DID deny ALL those referrals, I am getting a lawyer. I am sick of this crap. I NEED to see my cardiologist..my heart is even more erratic, and I get chest pains. I could drop dead of a freakin’ heart attack, all because the damn referral either was denied or not ready. I don’t get it. I am so stressed about this. I can’t afford to pay $50 if the referral for my Rheumy doesn’t come through…I don’t even HAVE $50! I need my meds and I need to talk to him about the increase in tremors, chest pain (pleurisy), and other things. And stress isn’t good for someone with my medical conditions. Shit, it isn’t good for anyone! Anyhow, I did call a woman that works for the insurance…she helped me before to find a reproductive endocrinologist for my mysterious endocrine problems, and then helped me again to change the date on that referral as it was going to expire before my appointment (that’s another thing…the referrals usually only have a 2-3 month time span in which it is valid. If an appointment runs past that date, then I have to get another referral, and they only authorize 2 visits at a time, meaning that every other month, I need a NEW referral to see my Rheumy. The other insurance I had issued them for 12 visits or one year. Unfortunately, I had to change insurance companies because the one I had wasn’t serving this county anymore). So, I hope that the woman I called can help me get this mess straighten out. I did have a case worker at one time, but she wasn’t any help…all she wanted to do was question me about my medical conditions, my meds, and she also wanted to talk to my doctors about why I was on certain meds. When I found this out, I faxed all my doctors letters stating NOT to give ANY of my medical information out to this woman. She wasn’t helping in the way I needed, she was just nosey. OK, I am done rambling. I have to go lay down. I didn’t type this all at once, some of it is pasted for an email, but only the beginning. Sorry about that guys, but I just cant sit here. But then again, I cant sleep because of the pain. Crap, I need a laptop (out of the question though! LOL) Hugs to all, and hopes for a pain free day tomorrow Nikki "… lost in the darkness of my own circumstance, criticizing echoes leaving me awake in the night… the barrier and blockades that keep me safe and in control while I pretend that I am okay… "
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- Hide quoted text — Show quoted text – And, I had the same problem with my Prilosec…they wanted me to try OTC Zantac or Pepcid AC! I have tried them all, and I have severe reflux disease with erosion of the esophagus, so bad that I have to take the Prilosec twice a day, instead of the usual once a day (there is a new medicine that can help the erosion called Nexium, but I KNOW my insurance won’t cover it) Nikki, I can’t help you with the other stuff, but don’t waste any time trying to get Nexium. It’s only chemically slightly different than Prilosec and does no better job of treating esophageal erosion than Prilosec does. The deal is, the patent is about to come off of Prilosec and generics will come out. So the mfr. changed an isomer, thought up a new name, and put three gold stripes on the same purple pill. Voila! New patent, new license to print money. Best, mary BINGO Mary! You nailed that one down hard!!! Hope you are feeling better, how is the leg? Give Rick a hug from me just for being so good to you. Don’t tell him what it’s for or who it’s from just to keep ‘em guessing! Take Care, Deanie
Deanie, I found the info on the pharmacy group. I was taken in by the Nexium advertising, but something bothered me about the fact that they couldn’t claim anything different than Prilosec already does. Then I saw some posts from pharmacists and got the *real* story. Can’t bear weight on the foot yet, and it’s six weeks tomorrow. I go to the doc tomorrow to see about getting the boot off, but I’m not in a hurry considering that I can’t put my foot flat on the floor yet. I think I’ve hit the place where the prednisone is hindering the healing — not much, but just a bit. It’s a low but steady dose, and it has affected my skin and thus the incision, which is spectacular! Rick is wonderful, and I’ll be sure to give him that unknown hug! He is at a bris this morning, but since we don’t know the people I didn’t make the effort to go. But the grandfather wanted a male minyan (ten adults) so I don’t feel too bad about skipping this one. Thanks, dear. I know I still owe you a note — I haven’t forgotten! mary
Response:
The pharmacist on the sci.med.pharmacy said nexium and prilosec were basically the same.
Yes, that is basically correct. You were saying Nexium was the generic for Prilosec, and I was stating it was not. Robin Path: lobby!newstf02.news.aol.com!portc01.blue.aol.com!news.maxwell.syr.edu!fee
d2.news.rcn.net!rcn!newsfeed1.earthlink.net!newsfeed.earthlink.net!newsmas ter1.prod.itd.earthlink.net!newsread2.prod.itd.earthlink.net.POSTED!not-fo r-mail – Hide quoted text — Show quoted text – Newsgroups: alt.support.chronic-pain Lines: 77 X-Priority: 3 X-MSMail-Priority: Normal X-Newsreader: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 NNTP-Posting-Host: 63.49.232.21 X-Trace: newsread2.prod.itd.earthlink.net 995181702 63.49.232.21 (Sun, 15 Jul 2001 00:21:42 PDT) Organization: EarthLink Inc. — http://www.EarthLink.net (newsmaster1.prod.itd.earthlink.net) The pharmacist on the sci.med.pharmacy said nexium and prilosec were basically the same. Nicole, Nexium is not the generic for Prilosec. It is stronger than Prilosec. Prilosec is 20mg per dose and Nexium is 40mg per dose. Prilosec can be taken once or twice daily and Nexium is taken once daily. My Dr. just started me on Nexium. I find Prevacid works much better for me. Robin Path: lobby!newstf02.news.aol.com!portc01.blue.aol.com!news.maxwell.syr.edu!net news.com!xfer02.netnews.com!newsfeed2.earthlink.net!newsfeed.earthlink.net !newsmaster1.prod.itd.earthlink.net!newsread1.prod.itd.earthlink.net.POSTE D!not-for-mail Newsgroups: alt.support.chronic-pain Lines: 16 X-Priority: 3 X-MSMail-Priority: Normal X-Newsreader: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 NNTP-Posting-Host: 63.49.236.64 X-Trace: newsread1.prod.itd.earthlink.net 995149105 63.49.236.64 (Sat, 14 Jul 2001 15:18:25 PDT) Organization: EarthLink Inc. — http://www.EarthLink.net (newsmaster1.prod.itd.earthlink.net) Nikki I’m so sorry you are having such crappy luck with your insurance. Have you tried calling Member Services? Member Services should get all your referrals done right away. As for Nexium, your insurance may pay for it since it’s the generic for Prilosec. Prilosec’s patent is up and they’ve come out with Nexium. I take Protonix (a proton pump inhibitor like Prisolec) and it’s cheaper than Prilosec. There’s also Prevacid (another PPI). I take the Protonix and 300 mg Zantac a day. Good luck fighting with the insurance!!! Start filing complaints! Nicole I am *not* a Medical Doctor (MD) or *any* other type of Medical Professional. PLEASE consult your own Dr. for medical advice. The information posted is information I have learned from researching or learning from my own disease.
I am *not* a Medical Doctor (MD) or *any* other type of Medical Professional. PLEASE consult your own Dr. for medical advice. The information posted is information I have learned from researching or learning from my own disease.
Response:
I wrong about it being the generic. Guess I thought it was since it’s the same thing and made by the same company. But Nexium isn’t necessarily stronger than Prilosec. There are different dosages for Prilosec and Nexium. Fortunately, the Protonix works for me… I’ve taken Prilosec and Prevacid and those worked too. With the Zantac thrown in there, it’s a wonder I have any stomach acid left. Nicole
– Hide quoted text — Show quoted text – The pharmacist on the sci.med.pharmacy said nexium and prilosec were basically the same. Yes, that is basically correct. You were saying Nexium was the generic for Prilosec, and I was stating it was not. Nexium is not the generic for Prilosec. It is stronger than Prilosec. Prilosec is 20mg per dose and Nexium is 40mg per dose. Prilosec can be taken once or twice daily and Nexium is taken once daily. My Dr. just started me on Nexium. I find Prevacid works much better for me. Robin Path: lobby!newstf02.news.aol.com!portc01.blue.aol.com!news.maxwell.syr.edu!net
news.com!xfer02.netnews.com!newsfeed2.earthlink.net!newsfeed.earthlink.net !newsmaster1.prod.itd.earthlink.net!newsread1.prod.itd.earthlink.net.POSTE – Hide quoted text — Show quoted text – D!not-for-mail Newsgroups: alt.support.chronic-pain Lines: 16 X-Priority: 3 X-MSMail-Priority: Normal X-Newsreader: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 NNTP-Posting-Host: 63.49.236.64 X-Trace: newsread1.prod.itd.earthlink.net 995149105 63.49.236.64 (Sat, 14 Jul 2001 15:18:25 PDT) Organization: EarthLink Inc. — http://www.EarthLink.net (newsmaster1.prod.itd.earthlink.net) Nikki I’m so sorry you are having such crappy luck with your insurance. Have you tried calling Member Services? Member Services should get all your referrals done right away. As for Nexium, your insurance may pay for it since it’s the generic for Prilosec. Prilosec’s patent is up and they’ve come out with Nexium. I take Protonix (a proton pump inhibitor like Prisolec) and it’s cheaper than Prilosec. There’s also Prevacid (another PPI). I take the Protonix and 300 mg Zantac a day. Good luck fighting with the insurance!!! Start filing complaints! Nicole I am *not* a Medical Doctor (MD) or *any* other type of Medical Professional. PLEASE consult your own Dr. for medical advice. The information posted is information I have learned from researching or learning from my own disease. I am *not* a Medical Doctor (MD) or *any* other type of Medical Professional. PLEASE consult your own Dr. for medical advice. The information posted is information I have learned from researching or learning from my own disease.
Response:
Hi Nikki, I’m sorry to hear you’re feeling so lousy, and have to fight the insurance company at the same time. (what do these people think, you have so much fun visiting all these doctors that you make appointments just for the social visit???). Anyway, I’ve worked in many x-ray departments as a technologist for more than 25 years, so I thought I could add my 2cents to Sonjia’s comments.. They use gastrograffin on me which is actually water soluble….
. Gastrograffin is quite expensive but maybe you could ask for that… It isn’t a nice taste at all…
Do not hesitate to request Gastrograffin, cost is not an issue, you won’t personally have to pay for it. Additionally, Radiologists should know better than to give someone with your history barium. As for the taste.. well….. ok, one department I worked in used to mix the gastrograffin with Tang (the stuff NASA uses, haha). So, if you can, bring along some sort of flavored powder (Crystal light??), and ask the Technologist (or ask to speak to the Radiologist beforehand), then you can request the gastro and at the same time ask if they would check with the Radiologist about adding the powder to the gastro to make it more tolerable. It will NOT interfere with the exam (we used it routinely for CT scans because the barium was too dense). I hope this helps you, and anyone else having GI studies. Mary-Ellen
Response:
– Hide quoted text — Show quoted text – And, I had the same problem with my Prilosec…they wanted me to try OTC Zantac or Pepcid AC! I have tried them all, and I have severe reflux disease with erosion of the esophagus, so bad that I have to take the Prilosec twice a day, instead of the usual once a day (there is a new medicine that can help the erosion called Nexium, but I KNOW my insurance won’t cover it) Nikki, I can’t help you with the other stuff, but don’t waste any time trying to get Nexium. It’s only chemically slightly different than Prilosec and does no better job of treating esophageal erosion than Prilosec does. The deal is, the patent is about to come off of Prilosec and generics will come out. So the mfr. changed an isomer, thought up a new name, and put three gold stripes on the same purple pill. Voila! New patent, new license to print money. Best, mary BINGO Mary! You nailed that one down hard!!! Hope you are feeling better, how is the leg? Give Rick a hug from me just for being so good to you. Don’t tell him what it’s for or who it’s from just to keep ‘em guessing! Take Care, Deanie Deanie, I found the info on the pharmacy group. I was taken in by the Nexium advertising, but something bothered me about the fact that they couldn’t claim anything different than Prilosec already does. Then I saw some posts from pharmacists and got the *real* story. Can’t bear weight on the foot yet, and it’s six weeks tomorrow. I go to the doc tomorrow to see about getting the boot off, but I’m not in a hurry considering that I can’t put my foot flat on the floor yet. I think I’ve hit the place where the prednisone is hindering the healing — not much, but just a bit. It’s a low but steady dose, and it has affected my skin and thus the incision, which is spectacular! Rick is wonderful, and I’ll be sure to give him that unknown hug! He is at a bris this morning, but since we don’t know the people I didn’t make the effort to go. But the grandfather wanted a male minyan (ten adults) so I don’t feel too bad about skipping this one. Thanks, dear. I know I still owe you a note — I haven’t forgotten! mary
Dear Mary: I know you haven’t forgetten but you worry about getting better right now…and keeping Rick off his toes! Be good to yourself okay? Take Care, Deanie
Response:
BTW, Pepcid is now available as a generic, and if your doc orders 20mg tabs (double the OTC strength) you can get it via generic RX instead of OTC. OTC is sooo expensive !
– Hide quoted text — Show quoted text – Nikki I’m so sorry you are having such crappy luck with your insurance. Have you tried calling Member Services? Member Services should get all your referrals done right away. As for Nexium, your insurance may pay for it since it’s the generic for Prilosec. Prilosec’s patent is up and they’ve come out with Nexium. I take Protonix (a proton pump inhibitor like Prisolec) and it’s cheaper than Prilosec. There’s also Prevacid (another PPI). I take the Protonix and 300 mg Zantac a day. Good luck fighting with the insurance!!! Start filing complaints! Nicole
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