Obamacare is supposed to be this panacea that will provide health care to the masses, and will solve the problems in the system. Well, if what I went through over the last two weeks is any precursor to what Obamacare will be like, God help us, we are in for the most dehumanizing, demoralizing, aggravating experience we could ever ask for.
My wife has been on a prescription medicine for years! Until the spring of 2010, we got it through her private health care plan through the bank where she worked. Last spring, she resigned and went to work at a location where she does not have health care, so I put her on my military retirement health care plan called TRICARE & EXPRESS SCRIPTS.
As soon as we went on the military plan, they told us that my wife's name brand medication was not approved without a Doctor's orders, so they gave her a generic. She took the generic and started having severe problems, so we did whatever we had to do at that time, and they started providing her the name brand in ninety day supplies. All was well until about two weeks ago.
I called the prescription in for refill, and they told me that it was not covered, that we had to get a pre-authorization from her doctor. I told them we'd already crossed that bridge back nine months ago, but they said that they could not find a pre-authorization, so they would not fill it. I reminded them that we'd fought the battle once before, and that they had been providing the name brand for over 180 days; their response...there is no pre-authorization on file, therefore they could not fill it.
After fighting with them for the next two days, at times having my blood pressure near the point of blowing the top of my head off, I realize that all I am doing is alienating everyone at Express Scripts and TRICARE Southern Region, so I tell them that they need to FAX the pre-authorization form over to my wife's doctor so they can complete the pre-authorization form and get it to them so my wife can get her prescription refilled, which they do.
Next day, I call them and find out that my wife's nurse had talked with Express Script's pre-authorization department and spent twenty-two minutes explaining why my wife needed the name brand (e.g., that she had tried the generic, it gave her severe stomach cramps and other problems; that they had already talked with Express Scripts in the past, and that my wife had been getting the name-brand prescription for over 180 days)
The person my wife's nurse is talking with continues to pursue how my wife reacted to the generic; actually asked the nurse if my wife had gone into anaphylactic shock from the generic! The nurse said "no", and re-iterated my wife's problems, then they hang up.
When I call the next morning, I find that the pre-authorization application was declined! Apparently, the severe stomach cramps and other problems my wife had did not meet TRICARE/EXPRESS SCRIPTS criteria for approval. I guess they feel like unless a woman goes into anaphylactic shock, the negative reactions are not strong enough to cause them to want to pay a few dollars more to not have her suffer the side effects.
Now, I am mad. I call the companies back and demand the name of the person(s) at Express Script that denied the pre-authorization. It is my full intention to sue them if my wife suffers any side-effects if in the end she relents and is forced to try the generic form of her medication. I will not permit that.
I have informed these two companies that they have lost their minds; that my wife is not a guinea pig, that I will not have her risking the reactions that she had before, and that eventually they are going to give her the proper medications under our coverage. I informed them that I have sent a five-page letter, which I am certain that will never get beyond these politician's flunkies that screen their mail, but I sent the letters to the President, Senator Landrieu, Senator Vitter, Representative Rodney Alexander, Mitt Romney, Newt Gingrich, Rick Santorum, Ron Paul, Senator John McCain, and former Governor Sarah Palin. I hope that one of them will at least get the word what a disaster this health care system for the military is now, and how much worse it will be under Obamacare when twenty or thirty million more people are pushed into the system at one fell-swoop, then the doctor's tell the plan to take a hike because they are constantly getting their fees cut and being forced to treat the patients according to some guideline that was drawn up by Washington bureaucrats rather than a plan agreed upon by doctor and patient.
My wife received a letter today from Express Scripts telling her that the pre-authorization application did not meet TRICARE'S criteria, and that now we must go through what is known as a medical appeal (we'd already started this last week; we were told by one of the people that I screamed at while being told that, for all practical purposes, my wife would have to suffer life-threatening symptoms before they would approve the name-brand medication instead of the generic). My wife had to write a letter to her doctor giving the doctor the right to negotiate with TRICARE/EXPRESS SCRIPTS for her, and asking for the name brand medicine, and the Doctor would have to write a letter to them explaining the medical justification for the name-brand. So...my wife has to waste more time, the doctor has to waste more time, and some committee in St. Louis will decide the final outcome of the clinical appeal. Great!
Think about what the decisions and policies that are in place now have told my wife and I:
· You and your doctors can no longer decide what is the proper medication to treat you with; it will be decided by a person or committee that does not know you, and who is paid to minimize the expenditures required under your medical plan to provide you with a treatment plan, instead of paid to cure you or relieve your symptoms, and is governed by an anonymous individual or committee hundreds or thousands of miles away from your doctor and you, that has never met you.
· Severe stomach cramps and other complications associated with a medication are not enough problems to justify providing your wife with a name brand medication that she has been on for years with NO complications. Instead, you must take a generic medication that, the first time your wife took it, caused her severe stomach cramps and other complications, just so the government can save a few dollars on a prescription
· When your wife’s nurse answers “no” to the question “Did she go into anaphylactic shock when she took the generic medication?” then her problems with it are not severe enough to justify the name brand medication. Let’s see…does that mean that it takes a near-death reaction before the insurance company would think it justified to replace the generic with the name brand?
Welcome to the world of government controlled medical care. The great social experiment is already in full force, and it stinks! If any of the readers are the recipients of this type of treatment under the government's plans, then I strongly suggest that you call and raise all sorts of a stink to your senators and representatives. Remember; if the wheel squeaks loud enough, somebody's going to put a little grease on it.
My philosophy right not...kick every elected politician out of office and start over! Put term limits on them, make them live by the exact same plan(s) that we have to live under; no golden plans for politicians; cut their pay, pass a balanced budget amendment, repeal Obamacare at the earliest opportunity, and make them reduce the deficit by 15% per year until it is eliminated.
Remember this, Thomas Jefferson said these words that have certainly come to pass over the last two hundred thirty-three years!:
"Experience hath shewn, that even under the best forms of government those entrusted with power have, in time, and by slow operations, perverted it into tyranny.", and...
"Every government degenerates when trusted to the rulers of the people alone. The people themselves are its only safe depositories."
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