Naomi Gayle Rivkis (pocketnaomi) wrote,
Naomi Gayle Rivkis
pocketnaomi

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Update: (re: Calling for Help)

OK, first let me say a huge thank you to everybody who contributed valuable advice as well as just plain sympathy and good wishes about the pile of unbelievable crap my health insurance company has decided to pile on my head. I've spent the last two days frantically researching and calling everyone on the planet who could possibly be able to help me sort it out, and it looks as if I have a plan.

Step 1: pick up my July's supply of Lyrica in June, before the July 1 cutoff date after which they won't cover it anymore. That's being paid for by my mother, since I didn't expect to have to refill it till into July so didn't have the extra... and it's over $200 even with the insurance company's share.

Step 2: Get the pharmacy to fax an invoice over to the NW Network, the incredible group of guardian angels who have been running my support groups, listening to me whimper by phone for an hour once a week, researching the law for me, and otherwise doing absolutely anything a DV survivor could possibly need help with, whether it has anything directly to do with my ex or the assault or not. The Network will give me a check made out to the pharmacy, for the amount of August's supply of Lyrica, in full.

Step 3: While in New York, attempt to fill the August supply of Lyrica, preferably a few days early so there's some wiggle room for everyone to do their thing. (I can do this from a continent away because Walgreen's has branches everywhere; as much as I normally loathe the big nationwide/multinational corporations, they do have occasional advantages.) The pharmacy will try to run it, get it bounced because it's nonformulary, and tell me, "Sorry, we can't get insurance coverage. Do you want to fill it anyway?"

Step 4: At this point, I do two things. I hand them the check from the Network and tell them, "Yes, I do; here's the money for it." I also tell them, "Please fax my doctor the forms he will have to fill out in order to get an override from the insurance company for this medicine in the future."

Step 5: My doctor, whose very kind and sensible nurse has just taken down all the information from me that he's likely to need about which other medications I have tried and why none of them are remotely possible in my particular case, will fill out forms, call and yell at them, or do whatever else he needs to do in order to get September's supply (and all later supplies until the company does something else obnoxious). If there is any information he needs which I haven't already supplied him, or if there is anything I have to fill out personally in order to get the appeal through, his office will call me and tell me.

Step 6: While all of this is going on, however, I have my August supply already paid for by the Network, so I have a month in which to see what the result is. I will meantime have filled out the form for the Pfizer assistance program, and gathered all the documentation I need in order to apply for it. I won't send that form yet. I'll hold it, and if the appeal is turned down, I'll still have a couple of weeks' supply (and the Network has said it might be able to spring for another month if absolutely necessary) with which to function until Pfizer makes a decision.

I think this will work. I think.

This entry was originally posted at http://pocketnaomi.dreamwidth.org/13749.html. Please comment there using OpenID.
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