Your Latest Bump
By Amber
@AmbiePam (120533)
United States
June 6, 2023 10:50am CST
Well, I went to my second doctor appointment of the week, expecting a slight medication change (which I wanted). And indeed, my doctor ordered a medication change. Twenty seconds after I stepped out of her office (I was impressed with the speed), I got a text telling me the new medication would need a prior authorization. 
Yeah, most of you guys know what that means; the insurance is not going to pay for it automatically. Instead, the doctor has to fill out a lot of paperwork to appeal to the insurance on why this particular medication is necessary for me. In my 17 years of being on Medicaid, I have never once had a prior authorization for a medication be approved. So I knocked on my doctor’s office door, and told her about it. She said she’d appeal it anyway to get it approved.
Sigh. I left the doctor exactly as I’d entered it. Even if they approve the PA, it will take weeks, if not months. 
What is your latest bump in the road?
Yeah, most of you guys know what that means; the insurance is not going to pay for it automatically. Instead, the doctor has to fill out a lot of paperwork to appeal to the insurance on why this particular medication is necessary for me. In my 17 years of being on Medicaid, I have never once had a prior authorization for a medication be approved. So I knocked on my doctor’s office door, and told her about it. She said she’d appeal it anyway to get it approved.
Sigh. I left the doctor exactly as I’d entered it. Even if they approve the PA, it will take weeks, if not months.
What is your latest bump in the road?25 people like this
27 responses
@DaddyEvil (174208)
• United States
6 Jun 23
Pretty and I have trouble getting the medications approved through Medicaid, too. My doctors send in paperwork and some of the meds are finally approved and some aren't... The funny thing to us is that Pretty can be approved for some things that I can't... One of my blood pressure meds is Clonidine... It was originally prescribed by the doctor as a slow release needing only one tablet per day... Medicaid refused to pay for that but agreed to pay for two of the not slow release tablets a day instead. (Pretty was prescribed the same slow release pill and was approved for it by Medicaid. 
*sigh*)
*sigh*)6 people like this
@AmbiePam (120533)
• United States
6 Jun 23
@DaddyEvil A wonderful, and perfectly logical question.
3 people like this
@DaddyEvil (174208)
• United States
6 Jun 23
@AmbiePam I always wonder why "they" are allowed to overrule our doctors.
4 people like this
@rebelann (117196)
• El Paso, Texas
6 Jun 23
Wow, that's really nice of you.
I wish the best for you as well, I don't take any meds so I'm not really sure whats up with all that but I do know that insurance companies can be a big pain in the butt. I hope they'll approve all of it very soon.
2 people like this
@snowy22315 (208746)
• United States
6 Jun 23
Grrr,,,it's always something. I guess the med must be expensive or something. Maybe the med will be approved sooner than you think. My latest bump in the road...well I guess having to wait a long time for the new internet service.
3 people like this
@AmbiePam (120533)
• United States
6 Jun 23
Yeah, it probably is. And sometimes, I’ve actually gotten aggravated at my doctors for even trying to prescribe a medication. My neurologist once called in a prescription where per pill it is $100. One hundred dollars! I don’t blame the insurance for not wanting to cover that! I didn’t understand why she bothered.
But I’ll be honest, and I feel self-conscious. This medicine is for my depression. And when it’s for my mental health I don’t care what it costs; I just want to feel better. 
4 people like this
@AmbiePam (120533)
• United States
6 Jun 23
@snowy22315 I have never heard of it, but I will look it up. I am more than willing to try all things natural.
3 people like this
@snowy22315 (208746)
• United States
6 Jun 23
@AmbiePam Yes, that is understandable, whether for mental or physical it is important. Have you tried Ashwaganda? it is good for that and available OTC.
4 people like this
@AmbiePam (120533)
• United States
6 Jun 23
It just amazes me. It’s not a doctor saying I don’t need it, it’s an insurance company saying I don’t know you, or anything about you, but I will not pay for this medication unless your doctor sends me an an overwhelming amount of proof that you need it. And then they turn me down.
Fortunately, some people have good insurance, and their company approves prior authorizations. It boggles my mind that some people don’t have to get them at all. I’ll try to be thankful for what I can get, and pray for once, they approve the PA. 
2 people like this
@Juliaacv (56195)
• Canada
7 Jun 23
@AmbiePam Here the pharmacist makes you sign for narcotics.
It is basically to clear them if you have a robbery just for the pills.
I remember when my Dad passed my mother told my hubby that she couldn't part with his slippers, and would always leave them on the floor on his side of the bed, and leave his container of medications in the kitchen cupboard as it was comforting to her.
My hubs quietly yet seriously suggested that she give him the pills as he would take them into the pharmacy to dispose of before she had a robbery for them. It was no secret in their area that he was awfully sick before he passed and that he probably had alot of meds in the house.
2 people like this
@Juliaacv (56195)
• Canada
7 Jun 23
@AmbiePam I hope that the insurance company approves the medication. If you need it and the doctor feels it can bring an improvement to your health then I hope that it happens.
I get it about the depression and keeping it to yourself. Some people deal with it best that way, and we all have to do what works best for us.
1 person likes this
@Tampa_girl7 (54714)
• United States
6 Jun 23
I know that is frustrating. I pray that it will be approved.
2 people like this
@Butterfingers (66603)
• India
6 Jun 23
Oh that seems too slow. I hope they can expedite
3 people like this
@RebeccasFarm (91299)
• United States
6 Jun 23
I hate when that happens and they never pay for it for me. They are the living end. Sorry Ambie and I hope it gets approved.
Bump in the road here was me spilling half a bottle of ammonia all over my place here this morning when I had an appointment to get to.
1 person likes this
@RebeccasFarm (91299)
• United States
6 Jun 23
@AmbiePam Yes I still have a headache from it..stinks lol
1 person likes this
@LadyDuck (502148)
• Italy
7 Jun 23
Oh my, this is insane, a lot of paper works and wasted time and a so long waiting, I am sorry.
My latest bump? We received the report from my husband angiologist, I called his personal doctor to discuss the matter... the doctor is vacationing until June 19.
1 person likes this
@Marilynda1225 (91011)
• United States
6 Jun 23
I really hope they can get this approved without too much hassle and you can get the meds quicker than you expect.
1 person likes this
@Marilynda1225 (91011)
• United States
6 Jun 23
@AmbiePam I don't think it's being pessimistic. Trying to get a medication approved can be time-consuming and there's always red tape involved. Hope it goes through so you can switch to the new meds
1 person likes this
@Metsrock69 (3617)
• United States
6 Jun 23
My kids told me that They can't afford to pay for their phone bill right now so I just have to do a few more assignments monthly and I will be good until they get caught up
1 person likes this
@LindaOHio (222222)
• United States
7 Jun 23
I hope it gets approved without a hitch. There's always a bump of some sort...right now things look pretty good. Maybe I shouldn't have said that. lololol
1 person likes this
@LindaOHio (222222)
• United States
8 Jun 23
@AmbiePam Thanks. He is doing much better and has his follow-up appointment today.
1 person likes this
@MommyOfEli2013 (89450)
• Rupert, Idaho
7 Jun 23
I have had to deal with that twice in the past year myself, needing a medication to have prior authorization. Both times it was an insulin that the doctor prescribed. Hopefully that won't take that long for yours! For me it took about a week each time
1 person likes this
@AmbiePam (120533)
• United States
7 Jun 23
@MommyOfEli2013 Absolutely, insulin is vital. They better have coughed up the money for that!
@MommyOfEli2013 (89450)
• Rupert, Idaho
7 Jun 23
@AmbiePam I think the one insulin is just more costly than other brands so they did not want to pay for that brand. The other one I never have trouble with lol
1 person likes this
@MommyOfEli2013 (89450)
• Rupert, Idaho
7 Jun 23
@AmbiePam Well they kept saying no for a week....so I had to go to a different kind as I had run out. Luckily I am not type 1, but I don't make very much insulin myself anymore.
No problem....dealing with meds and the pharmacy is always a pain! I thought it might have been those kind of meds. $100 per pill? That's insane! It does make sense why then but still....! The insulin is oer $1,000 so I get that too... but some meds are needed to live, or at least function...
1 person likes this
@ainnaqo66 (303)
• Indonesia
11 Jun 23
I'm trying to understand the discussion. Is Medicaid the health insurance company in your country?
1 person likes this
@AmbiePam (120533)
• United States
11 Jun 23
Medicaid is insurance the government directly pays for, and I only have it because I’m on disability. But it’s okay because amazingly, the insurance approved the prior authorization, which they have not done in all the 17 years I’ve had it. So I was able to start the medication today.
I’m sorry my post wasn’t clearer. I should have gone into a little explanation at least for what Medicaid is.
I’m sorry my post wasn’t clearer. I should have gone into a little explanation at least for what Medicaid is. 1 person likes this
@ainnaqo66 (303)
• Indonesia
12 Jun 23
@AmbiePam it is fine i think it was not necessary. it was just me, most of myLotters knows what it is. 
And i am glad you're able to start the medication, Amber. i really hope the medication goes smoothly always.
And i am glad you're able to start the medication, Amber. i really hope the medication goes smoothly always.1 person likes this
@GardenGerty (169406)
• United States
7 Jun 23
I am so sorry you still have to wait, and hope. It is like banging your head against the wall. My latest bump is the trouble I have with my computer.
1 person likes this
@allknowing (153544)
• India
7 Jun 23
I get reimbursed through my husband's office and so far so good.
1 person likes this
@averygirl72 (38847)
• Philippines
8 Jun 23
I hope it would be approve. It's one week from now when I had a very big bump in the road
1 person likes this
