It Never Ceases To Amaze Me

I get all riled up over something.  Today it was my insurance denying my RX claim.  I’m beyond irritated and ranting.  I get home, settle in (bra flies off, just like Frankie Heck from the Middle – funny huh? but topic to follow is NOT!) and then BOOM! Something comes along that knocks me back to reality. I am reminded of my daddy and I can almost hear his voice “No harm done, it could be worse”

You see he always started with no harm done to put things into perspective.

Lulu, Wise and I are celebrating our 3rd annual December birthdays spa day this weekend. Belated to January because Wise has a new job with traditional hours.  Anyhow, Big B squared is home this year (no hunting as the family ranch land was sold so the in-laws have a means to feed their gambling addiction).  Wow, I am a bitter old broad.  Moving right along …

Billy-Bob called Pony to ask if he was available to do something while we girls have our spa day.  That’s when the BOOM happened.  Pony doesn’t know because his friend killed himself and the funeral might be Saturday.  What?!??  Wait!  Stop!!  Not again!!!

I’m hearing 3rd hand so in turning over my new leaf to participate in life, I picked up my phone to call MY boy.  It went straight to voice mail but he called me back quickly.  The conversation went something like this:

Pony: Hey you called?

Me: Yes, did you hear my message?  I get it if you don’t want to talk but I want you to know that I am here.  I love you sonshine ❤

Pony: Well I talked to his wife and she has so much shit to deal with.  I didn’t ask her for details; I don’t want to know how he did it and we’ll never know why.

Me: Are you okay?  I don’t remember the name or you talking about him

Pony: Me? I’m fine, I guess.  He’s not from high school.  I met him through B.  He went to Palo Alto then UTSA with him.  We liked the same music and for the last three years, we went to all the same concerts.  That’s the kind of friend he was … not Brando close but this … I didn’t except this

No words.  What can one say?  Nothing.  Life is fragile.  Do we ever really know anyone?  Who knows what may be just beneath the surface, causing so much pain? Cause of Death: Suicide.

Suicide Prevention Life Line – Spread the word.  NOW!!! Not just during the month of September.  I’ll be praying and lighting candles at San Fernando tomorrow.  Hugs bloglandia.  Hugs to all of you!

As always, more to come.

 

Rant Of The Day- Bend Over And Get Yours!!

Today’s rant is sponsored by health insurance in America still sucks as those   in the system lines their pockets with people’s misery.  
I’ve been taking name brand Crestor for 13 years. This was after exhausting all other alternatives … every statin on the market at the time.   They didn’t work, most had side effects and then wa-lah the dream Crestor worked!

No this is not a paid advertisement for Crestor. This is the back story of how you get screwed over by insurance.  I mean really if you think about how effing crazy it is people are screwed over every day.  And I know I’m one of the lucky ones because I have employer sponsored health insurance.  But this is still ridiculous.  I want to fight not just for me but for all consumers.  

When we had Insurance plan A, I paid $45 for my RX.  A higher copay but still covered.  Then Insurance plan A was bought out by Insurance plan X last year. Fortunately because I’m on the lowest dose necessary and even only needing a half of that, I didn’t need a refill in all of 2016. Now it’s 2017 and I finally do you need a refill and guess what?!?   I’m DENIED!  

Let the games begin. I’m jumping. Hoop after hoop.  Plan X  tells me they can’t help me.  I have to go to CM. They have some kind of broker deal where the pharmacy part is administered by CM. Can you say pyramid scheme? <cough>  

First, the doctor submits the prescription as brand name medically necessary. SLAP DOWN. 

Second, get doctor to fill out a pre-authorization. That’s done. Pharmacy tech tells me prescription will be ready today for the low low price of $149. ✅ 

However before I could take a walk to go pick up my prescription on this lovely sunny day, I get a phone call basically saying – JUSTKIDDING!  Denied again!  And now the first appeal process has begun.   I’m told if that gets denied, there’s a second appeal process. I asked what happens if that is denied? I’m told we don’t know?!?! it’s never got that far.

I wonder why?!??  because the poor consumer is exhausted and just fucking gives up or because the insurance company does the right thing and finally freaking pays for the prescription.  

It’s a sad state of affairs my friends when I can get a prescription for Xanax for $1.83 but I can’t get fucking Crestor which is a lifesaver for me.  Sure, I can get the goods.  If I pay out-of-pocket,  it’s over $900.  Tell me again why I have prescription drug coverage on my insurance plan if I’m going to have to pay $900 for the prescription I really need???  BROKE ASS system!

So now we wait as the first appeal process rolls along at a snails pace.  I’ve been on the Internet during my lunch break looking for a Canadian pharmacy.  I know other people in my boat and that was a recommendation.  Of course this is where the FDA comes in with all the scary disclaimers about don’t do it … that the Canadians don’t meet standards … they mislabel drugs … you’re not really getting what you pay for and more.  If you’re so worried about the consumer, then fucking do the right thing to get involved and stop this insanity.  

It’s a crooked rigged system and it’s against us!  

Does anyone out there in bloglandia  have any experience, suggestions or recommendations on what I can do?  Any feedback is welcome and appreciated. 

As always, more to come.