Joe,
For the last 2 years my husband has been significantly suffering with pain in his knee. He used to be a Paratrooper in the Army for 8 years. It finally got to the point that he had to have total knee replacement. So last Tuesday he was admitted to the hospital and had knee replacement surgery. He was discharged from the hospital on Friday and was given a prescription of Percocet to help with the pain.
On Saturday a physical therapist came to our home and evaluated my husband. He had a fever, elevated blood pressure, swelling and pain in the entire leg and red streaks in his thigh area. So she contacted the orthopedic physician and we went to the emergency room Saturday night to rule out blood clots and infection. Thank God it wasn't a blood clot. They did start him on antibiotics and we were told to follow-up with the doctor on Monday.
So this afternoon we went into the doctor. The doctor decided that he had an excessive amount of fluid in the knee area and that he needed to drain fluid off of his knee. When we were finished he decided to give him a prescription for oxycontin extended release to help with pain. So we went to the Rite Aid in Berlin to get the script filled. They didn't have the medication so they called and found out that the Ocean Pines Rite Aid had the medication that he needed. Now comes the fun part. Rite Aid couldn't fill the prescription because the Coventry Insurance said it had to be pre-authorized by his doctor. Of course we find all this out after 5:00 p.m. so the doctor's office is now closed.
So I went outside to the car where my poor husband was waiting for me. I got the number out for Coventry and called. They said it usually takes 2 to 3 business days to get the authorization. WHAT? Since you already had to preapprove the freaking surgery who the hell do you think you are refusing to fill a prescription that the orthopedic doctor wrote in his office?? Yes it is a narcotic pain medication and it's not like we are asking for 3,000,000 of them. The script is for a total of 30 pills to get him through until some of the swelling, redness and pain subsides. We pay your stupid a$$es lots of money for your crappy insurance and this is how you treat someone who is suffering so much? How about this, why don't you come to my house tonight around 2:00 a.m. and watch my husband suffer and in tears because he is hurting so bad.
We have been in touch with the physician's office answering service. The on-call doctor is working to get this medication approved tonight so hopefully my husband can finally get some rest. You can't heal if you can't sleep. I have no complaints with the hospital, the doctors, the nurses, the techs and the physical therapists that have all taken care of him. Our experiences with all of them has been wonderful. I'm grateful for everything they did, have done and are trying to do to get my husband back to life.
COVENTRY, HOW DARE YOU TREAT MY HUSBAND IN THIS MANNER!! He gave up 8 years of his life defending our country and fighting for our freedom so that you can sit on your asses at your desks and make decisions for the doctors. Somehow you seem to forget the doctor is the one who is responsible for THEIR PATIENTS. What the hell is wrong with you? Since when did you go to medical school and have M.D. after your name??
You can rest assured that I will be filing an insurance complaint with the Maryland Insurance Administration and will be telling this story over and over again to whoever will listen. I wanted to start with you first Joe because I know that your blog is read by so many. It's time we all stand up and say enough is enough to these insurance companies. There has to be something that can be done so that this doesn't continue to happen. ENOUGH IS ENOUGH.
DelMarVa's Premier Source for News, Opinion, Analysis, and Human Interest Contact Publisher Joe Albero at alberobutzo@wmconnect.com or 410-430-5349
17 comments:
Pre approved from his physician? What the hell is a prescription? Pre approval" what a ridiculous insurance company.
To the anonymous commenter ATTACKING a veteran, YOU can kiss my ASS.
That comment will NEVER see the light here on Salisbury News.
If you don't like it, NEVER return and do us all a favor. In fact, pack your simple ass up and get the hell out of our country.
Coventry I believe is contracted out of Delaware, though many Marylander's have it for their coverage. The Maryland or Delaware Insurance Administration has been a wonderful help to many, and have solved issues for me personally, and at my employer's billing office (I work for a doctor.) Unfortunately where time is of the essence you will not have time to go through the channels THIS TIME, but you can make a formal complaint to the insurance commissioner for your state, and believe me, insurance companies do NOT like little marks against their company. Coventry should then flag your husband's policy as an exception to change this. Hope this helps
I'm sorry you had such a bad time with Coventry insurance.
We used to have that, before company was sold and insurance changed to Red Cross Blue Shield.
We loved Coventry and wish we had it back. It covered more and was cheaper than rcbs.
With rcbs we have a 2,400 deductible to pay before the benefits kick in.
I had back surgery to relieve pain I have been having for years and years.
At first it felt great but now I have pain in my hip and leg. Knee also.
I know exactly what you mean about being in tears from the pain. Been there and still am at times.
I'm just guessing but maybe they meant the oxy had to be approved since you already had perc's. ?
I know when you're in pain you don't care about anything except making the pain stop. Most people don't understand pain, and that includes doctors.
Pain management specialists are a little better but some of them don't totally understand pain and have the government breathing down their neck making sure they prescribe correctly.
I wish there was some way to transfer the pain we feel to people who make it difficult for us. Maybe then they would have some inkling of what we go through.
Hope you have better luck with Coventry in the future and this was an isolated incident.
Good luck, get well and I feel your pain.
Had a similar problem when I had Coventry. I just paid for the Rx (pain meds aren't all that expensive) and then fought for reimbursement later, which I got.
You always have the option to pay out-of-pocket for something that you really need. Pharmacy's rarely tell you that.
Craig Theobald
Ironshire
You always have the option to pay out-of-pocket for something that you really need. Pharmacy's rarely tell you that.
I would think that would be common sense.
I have Coventry and it has been wonderful insurance. I am a nurse and pre-authorizations are very common especially with narcotics. And no, just because a doctor writes a prescription doesn't mean it is always necessary. If that were the case we might not have so many people abusing prescription medications. The insurance company simply wants to know why your husband needs it. Your first mistake is going to Rite Aid. What kind of pharmacy doesn't stock Oxycontin? But if you are so unhappy with your insurance and take their policies so personally why do you use it? Be glad you have insurance and get over it.
From a Vet Joe. I think the DR could have made this better from the beginning. Not the fault of the Pharmacy. I'm sure Coventry paid the lion's share of a $40,000 knee replacement. Never seen one that didn't involve excessive swelling, pain,etc. Terrible operation. All insurance companies get a rap on this type of issue. I think the Dr's need to be more helpful and the offices need to know ALL insurance plans better to run interference for all their patients. If you think this is bad, wait for Obamacare IF it comes through. This will be an EVERY DAY occurrence folks. To the writer, I hope your husband gets better soon. I'd call the Dr and ask him/her why the office didn't call through. Most pharmacies are so restrictive on Type I narcotics and he/she should have known that and helped you from the beginning. My Dr has called the pharmacy I use so this is taken care of BEFORE I even arrive.
Stay away from that 'medicine' if you know what's good for ya. If your hurting for a couple o' days try some jack daniels.
A prescrip for pain meds after surgery is not unusual nor is 30 pills an unreasonable amount.
The problem in this post is a cycle that I believe stops right at the doctors offices and the reason why insurance premiums are so high. Over and unnessesary prescribing of medicines is rampant, costing the insurers hugh amounts of money.
There is a need to have a safeguard in place, so insurers aren't paying for unnessary drugs, but they also need to have in place something so someone like this veteran can get the meds at the time they are most needed.
Just wait for Obamacare.
first, you are coming off as entitled. yes, thank your husband for his service. however, that gets respect and, in some cases, handouts (well-deserved).
unfortunately, insurance companies are driven by the law and it is one of the most heavily regulated industries in the world. if you want someone to blame, go for the politicians that are getting the kickbacks and the greased palms.
also, insurance is nothing but a rip off. think about what you said, "we've paid you a lot of money." theres your problem. had you SAVED this money instead of given it to an insurance company, you wouldnt have this problem. the whole concept of insurance is backwards anyway. what you have basically said to them is: "here. you hold my money. if i need it, ill let you make me jump through hoops to get it. then you can only give me a portion of what i need. after kicking and screaming as to why you didnt give it to me, ill let you explain why you had 'exclusions' that were hidden from me."
insurance is the devil!!!
Don't bash just the insurance companies. The whole health care system is at fault. It starts with the hospitals who pressure doctors into using their facilities so they are compensated which amounts to many unnecessary surgeries and diagnostic tests. Fault also is at the feet of the doctors who don't speak out for fear of losing privileges and also the more tests, surgeries, etc they are involved in means more money for them.
Fault also lies with the drug companies who spend billions encouraging doctors to prescibe their drugs, many unnecessary.
Drug overprescribing among senior citizens is epidemic.
When the government gets it's hands on health care it will be five times the nightmare that these folks have gone through.If you know any Canadian residents, ask them.
Similar situation happened to my father when he was home with hospice, dying from cancer. Ridiculous. My mom ended up paying outright for the pain meds.
Your first mistake is going to Rite Aid. What kind of pharmacy doesn't stock Oxycontin?
You got that right. I went there one time, (at that time I always went there to get my meds), to get some pain pills. They told me the manufacturer went out of business and no longer made what the doctor ordered.
I left there, (and never went back), to Pemberton Pharmacy and they had it in stock.
Rite aid lost a customer and Pemberton gained one. They will even stop what they are doing and fill your prescription if you say you will wait.
They are on the other side of town from where I live yet they get all my business.
All it takes is good customer service and I will be a loyal customer.
Rest of these businesses in Salisbury could learn a thing or two from Pemberton.
My experience with Obama care has been horrible. It started as 3 day adventure. Bailed on doing this on line. Then multiple calls and 6 hours of my life later I had CoventyOne Health Coverage.
None of the doctors from my old plan were available and started over.
Now we start the real story. I pay my bills on-line and got this figured out with only 4 or 5 calls to various CovetryOne 800 numbers.
It looked like my original payment went through, so when I got slug mail to make a payment, went through the completely overly complimented process of making a payment on line. Got a confirmation number for my account (which showed the correct last four which is all you see)and was happy.
Now the nightmare starts. With i a couple weeks, slug mail comes indicating no payment made. I repeat the above on-line process with the same results. Make some more phone calls to Coventry. I get an offer to do direct deposit instead, but this is not how I do business. The last guy who is 22 years old and has no health coverage checks the checking information they have listed (I insisted) and guess what? Its wrong. I ask why I get a confirmation number, he indicated that the actual withdrawal happens 3 days later. I asked why no one bothered to call me after so many failed attempts to pay (this is a 4-profit company). I
Waited a day to make sure and made a payment. When I went in to check I found I had been cancelled. Maybe its for the best.
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