We’re entered an interesting phase in Terry’s healthcare experience. It seems we will now have to fight for some of what we think he needs.
He’s been denied a medication prescribed by his physician by his prescription drug carrier. Because he was prescribed Marinol for weight enhancement the insurance company made an interesting assumption. Terry was never contacted by them to find out why the drug had been prescribed. Since it’s used for appetite enhancement they made an assumption that he was anorexia. He had only gone through multiple prescriptions through their plan for anti-nausea and abdominal cramping over the past few years. They never contacted him or the prescribing physician’s office to verify the reason for the prescription.
The reason is weight loss post cancer treatment. It’s really not that difficult to find out why he needs to gain weight. It’s a nasty drug with nasty side effects, and we had decided it wasn’t worth the potential side effects when he was already going through so much. When the pharmacy finally let me know the problem, I mentioned that ice cream seemed a better weight enhancement option for him than the drug he had been prescribed. They did not disagree.
But the fact remains that under different circumstances and with a different patient, being denied medications by insurance companies undermines the decision of patient and doctor about what is needed. If I wasn’t looking online to show him what the medication did, or to talk with the pharmacy about why he wasn’t getting it, he would be a patient trying to muddle through a system that isn’t very patient or caregiver friendly. If this had been a drug he truly needed and I hadn’t been here to figure it out for him, it could have been a very negative situation. When patients pay for coverage, and doctors prescribe medications, insurance companies should only serve to make sure patient needs and doctor recommendations are met.
Does it matter if the drug costs $700 per month? Does that warrant the insurance company denying a medication for inaccurate reasons if the physician feels the patient would benefit? I have to believe it’s all about the money. They want to get as much of ours while preventing him from getting as much of theirs as they can.
The other issue at play has to do with Medicare. We still have not heard back regarding scheduling the diagnostic to find out if the nodule in his lymph nodes is the thyroid cancer making a comeback or not. For reasons unknown to us, Medicare is limiting how many of these diagnostic tests are available. We just need to find out what it is in the lymph nodes so we can address it as needed. Once again it will be up to us (me) to make this happen, and I’m again wondering how patients who don’t have family members to do this for them manage the system. They don’t make it easy for us, and I hope there aren’t too many slipping through the cracks as a result.
We’ve played the waiting game long enough, and I guess I’m going to have to take charge to get things moving. We’re trying not to worry, but it’s hard not to think about what might be happening with him that we don’t know about. We need to find out because we need to know. It’s past time.
