I truly believe this is a question both patients and physicians ask themselves quite frequently; Why are we spending so much time on insurance calls? This week alone, I spent upwards of three hours battling my insurance company to reinstate a medication that has proven to work for me for the past four years and suddenly is no longer covered by them.
I found this out at my oncologist’s office recently when I went in to get my Prolia injection. Since my second breast cancer diagnosis in 2014 I have successfully, with little or no side effects, taken this injection to prevent bone loss from the medication I am on, AI, to prevent my cancer from recurring. One of the side effects of the AI is bone loss and why I was prescribed Prolia. The Prolia was working! I was even on their Patient Co-Pay Program greatly reducing my out-of-pocket expenses. I have bone scans that report my bone loss has stabilized since taking the medication.
I don’t know who was more disappointed, my oncologist or me. The insurance company told my oncologist I must switch to a different medication, much cheaper, that has been around for years. It’s on the formulary on the prescription list so I can only assume insurance made this decision based on costs. The kicker, this medication causes potential GI issues and joint pain and presents these side effects more often than Prolia side effects. SIGH!! Until I try the medication and present with these problems, my oncologist cannot recommend that I go back on Prolia.
A Real Shot in the Arm!
Here you go breast cancer patient. Try this! It’s cheaper. If you get heart burn, acid re-flux, your jaw or joints start aching, oh, well, then we might consider something different for you. But hey, you survived breast cancer. You’re tough. Go ahead and give this a go. This is exactly how I felt after being told the news I could no longer take it.
My Solution with the Insurance Company ~ Speak as A Patient Advocate!
What did I do? I put my patient advocate hat on. I called insurance explaining to them I wrote more than one blog about the benefits I was receiving from Prolia. I have women ask me to reference the blog on various social media groups inquiring about Prolia. I tell them about my experience. I told the insurance company, I can’t tell those 10,000 women that anymore. How can you help me overturn this decision, so I can help other women and men on this medication after breast cancer understand why this decision was made? Oops! Sorry Twitter, Instagram, Facebook, and Google + followers. Never mind. I can’t take it any more because my insurance won’t cover it. At least not until I get sick on the other medication first.
What About Our Physicians Spending Precious Time with Insurance?
Now let’s turn to our physician friends, like my oncologist or plastic surgeon who spend inordinate amounts of their time away from their patients writing letters of appeal to insurance, so their patients can receive the best care possible. Maybe they write the same letter more than once trying their best to get approval! I’d rather have my healthcare team treating me, talking to me, caring for me, and not spending their precious time on the phone with insurance or writing letters. I’m guessing many of them do this after hours, too.
How much time are we, patients, and physicians, spending on the phone with insurance? Why has our insurance system become so complex when it comes to treating patients when our deductibles have risen, we are using precious revenue and resources to solve these problems, and denial after denial continues to face both the patient and physician?
What Was Your Experience with Insurance?
Tell me about precious time you have spent away from productive work or family dealing with insurance issues. Go ahead and rant. I took my turn. You get to take yours now. By the way, I have yet to solve my Prolia problem. I’m still waiting on approval and now my oncologist may have to spend more of her precious time on the phone or writing more documentation. I think she’s a rock star and I don’t think that’s fair to her or her patients!
Update: I had GI issues, I had bone pain for seven frustrating weeks. I called my oncologist office to report my symptoms. I’m back on Prolia. I’m still frustrated about this whole event. This is a small piece of a complex puzzle too many breast cancer patients are facing.
