And yes, at this point, I have to call and check every point on the chain to be sure each of the nested transactions complete. Because if I don’t faxes never get sent, or the person who has that file just isn’t in the office or the filing cabinet housing the crucial form is infested with rabid bats or whatever. I think that I got my point across, which is that I was going to keep calling, and that I was not going to let go.

I will be reserving the victory celebration for the minutes after I put the first syringe into the sharps container. I hope you understand.

The real WTF in this encounter is; why is my insurance company interfering with medical decisions? Most particularly, why are they interfering with the timeliness of time-sensitive medical treatments.

Also fax-machines? Are they still running their office on steam?

This is the listing for PacificSource at the state insurance divisions website.

If you are exercised enough to call them, please remember to be polite to the line level employees, they just work there.

Thanks for letting me vent.

update:they have everything they need; but the pharmacist is out of the office until 2pm.

PACIFICSOURCE HEALTH PLANS
110 INTERNATIONAL WAY SPRINGFIELD, OR 97477 Phone: (541) 686-1242	Cert of Auth. No: 108 NAIC #: 54976 Established: 1939 Entered OR: 06/20/1940	Agent for Service of Process: KENNETH P PROVENCHER 110 INTERNATIONAL WAY SPRINGFIELD, OR 97477 Domicile State: OR
Insurer type: HCSC
Authorized for: Health Care Service Contractor

Given that I give them more than I pay in rent each month, you would
think that they could live up to their minimal responsibility to
provide the drugs that they are contractually obligated to provide.

When I saw the doctor Monday morning, she told me (not that it was a
surprise), that if I didn’t get this medication soon, hospitalization
would be considered. I’ve been trying to get this medication for three
months; because I knew this was coming.

Hi, my name is Larry, I’ve been suffering from Psoriasis for most
of my life. I’m trying to restart a prescription for a drug called Humira
that is very effective; while on it I was as clear of psoriasis as I
have been in my adult life. My psoriasis is severe enough that I’ve
been hospitalized multiple times. When it’s really raging I can barely
walk, much less work at anything more physically strenuous than
tapping on a keyboard. I’m fairly sure that if it’s not kept under
control, and I get into a state known as ‘pustular exfoliation’ I
would probably die of septic infection.

My health insurance provider seems bound and determined not to cover one of the few medications that I know to be effective at letting me live a normal life.

The thing is that I was on this medication for about 2 years, before
they decided to start throwing obstacles in the way of renewing the
prescription. I went for a routine visit to my dermatologist in
April. He wrote a renewed prescription; the insurance company replied
that they needed a Tuberculosis test before they could approve the
medication; well since I was vaccinated with the BCG Vaccine as a child I of course test positive for the antibodies to TB. A fact which is easily discoverable to anyone with access to my medical records and which had already been determined at least once by the same insurance company. So two months go by, I get a chest x-ray to show that in fact I’m not wasting away from TB. I request my medicine, I’m told it’s in processing, and that the pharmacy will call soon, by this point I’ve been off the medications for two months, but I’m still doing OK. I’m busy with work, and various other projects (hey I have a life!) and I think that the medication flow will start in
July. During July and August, I’m calling the pharmacy every week, and they say they haven’t received authorization, I call the insurance company, and they deny all knowledge of prior authorization. This brings us to the last two weeks, I’m calling the pharmacy, the
doctor’s office and the authorizations department to see if my medication will ship.

Monday morning, I called from the doctors office, after speaking to the nurse who faxed the form twice in the last week; both times, the insurance company claims not to have received it. So I picked up a copy of the form and took it to the insurance companies office; to make sure they received it since apparently their fax machine is broken.

This morning when I called, the insurance authorization person I spoke to claimed that the clinic had “the wrong fax number”; I was looking at the form the clinic gave me at the top of which, in bold face is the correct (verified) fax number. They also want more data, which they have already received at least once.

Folks, this sort of thing is why we need to hold the health insurance companies to account; we need a public option, if only to change the dynamic of the industry.

I have decided to give my insurance company one last chance to make this right. But if the drugs are not shipping by 11am pacific time on Wednesday August 26. I will name them. It will be a new post so subscribe to the RSS feed now if you want to be the first to know.

So I’ve decided to share my story with the internet, for a couple of different reasons:

1. I’m getting sick, again, and that really sucks.
2. I want to name and shame my insurance company into doing the right thing.
3. I want to put a face to the debate over the public option and the need for health insurance reform.

My next post will be a long one, detailing exactly what has been happening between me and my health insurance company. It’s not pretty and it makes me mad as hell every time I think about it. In my viewpoint at this time, private health insurance companies are the moral equivalent of a mafia protection racket. I will tell you how I came around to that view. And hopefully you and I can work together to help fix this system and restrain the bad actors who are profiting from extending and worsening our illness and pain.