Friends, today I had the MOST amazing experience with pharmaceuticals.
Yes, with drugs! Prescription drugs, of course! (I am not like purchasing things on the street, although it was touch and go earlier this week.).
And of course, this short story is going to made long for each of you to enjoy! Buckle up, pop a B-12 so you don't dose off and keep reading!
On Tuesday, my son had an appointment with a GI specialist. We've been waiting for this appointment for 6 months. It was amazing, the doctor created a plan and the plan included a prescription med that was approved in 1989. Our insurance decided they required a preauthorization to fill the old time-y prescription that even my grandfather was alive to take.
A preauthorization is basically when your insurance company tells you that your doctor does not know jack about anything and they refuse to give you the meds without an additional doctor's note (outside of the prescription pad sort). Then your doctor writes back and their demeanor absolutely affects the speed of the outcome. I tend to pick aggressive, impatient doctors who write things like "THEY WILL NEED A VERY EXPENSIVE MEDICAL PROCEDURE TOMORROW WITHOUT THIS" or "SHE WILL BE A COMA BY THE END OF THE WEEK WHICH IS MORE THAN THAT DRUG."
Of course, they don't actually write in all caps, that is implied. They also use medical terms that mean the same as "they will die" and "I am the doctor who the fuck are you?", etc.
Anyway, what also affects the speed of your outcome is the mood of your insurance company and their preauthorization department. Barb, who is assigned to your case, could be in the midst of planning her daughter's bridal shower and taking PTO. She WILL NOT pass your case to Thomas. This is not a thing. So, for better or worse, you are also part of Barb's daughter's bridal shower, except you are unmedicated and not invited and certainly won't get a party favor.
Barb will accept gifts for her daughter. However, this will not speed her review of your doctor's note.
Anyway, the preauthorization process can take 15 days-15 years. It's ridiculous--mostly because they always seem to approve everything if you keep asking, even when they deny, they then approve it because they are either sick of your calls and your doctor's tone OR because they forget the plot and have no idea why they did not approve it 15 days ago.
It's dangerous, frankly. For my son, we were not in a danger zone but we were in the zone of frustration and madness. He's been struggling for 18 months and hit so many deadends. He's missed school and left school with stomach pain. Tuesday, we finally had a plan--a solid, smart analytical plan with the first step: take a medication for 14 days and let's see what happens.
Well, our insurance company was not into our timeline. I went from so relieved to help my son to infuriated that preauthorization was in my freaking way. I called the doctor, who was realistic but determined. My friend Heather told me to call insurance and I did and then I did again, as I promised Raj I would. My call today went like this:
"Hi Raj., this is Patricia Carrington-Adkins. As promised I am calling to check on my son's medication."
"Oh, yes, your son, the one who is a child."
"Yes Raj, you remember! Nicholas is a child. Why would you deny a drug approved in 1989 to a child? Is it because of the formulation? Because it is a capsule not a powder? The powder tastes like stomach bile, Raj. The capsule will taste like nothing. And I told you he can swallow Tic Tacs. Raj, Raj, Raj? are you still there."
Then a big breath.
"yes, let me check."
Then, another big breath.
"We have a letter from your doctor and it will be reviewed."
"Oh wonderful! I can hold while you review it!"
"We will call you! Have a nice day."
"Okay, I'll call back in ten minutes!"
Anyway, then like magic, two hours later I got a text that a prescription was ready for pick up. I went, just expecting it to not be the new pills and it to be one of my myriad of pills I take for all my chronic health conditions or the dog's insulin.
And then, then, I WAS HANDED A 30 DAY SUPPLY OF THE PILLS NICHOLAS NEEDS.
I was so excited that I almost stole them. I was scared they'd take them back! But they did not! I paid my $10 and now, friends, now I feel like I can conquer the world.
THIS IS THE POWER OF PRESCRIPTION MEDS!
I mean actually this is the power of having a fierce team. I am a pain in the ass and I am really good at complaining and advocating. I have so many amazing friends who push me along with wise advice and listen to my rambles. And Nick's new doctor is a rockstar. It takes a team, friends, to conquer the world and tomorrow, I am sure there will be a new problem to conquer, but I've got it.