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Thread: I'm sick and it's not my fault (Long rant)

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    Default I'm sick and it's not my fault (Long rant)

    12 days ago I went to my pharmacy to get my monthly refill of meds. I dropped them off but the pharmacist called me about 10 minutes later and told me that my insurance had been denied because my Tenncare (Tennessee public insurance, I’m uninsurable) was turned off. He told me to call my caseworker to find out what happened, so I called her as soon as I hung up my phone. She didn’t answer the phone so I left a message about the problem I was having and asked her to call me back as soon as she had a chance because I had less than a week’s worth of medication left. She called me back a few hours later and told me to come to the clinic the next morning and we would fix whatever the problem was.

    I went to the clinic that morning like she told me to, at the time she told me to. She wasn’t there, and wasn’t going to be back there the rest of the day. She asked if she could meet me somewhere the next day, and I told her that was fine, but that she needed to know I didn’t have enough meds to make it through the weekend, so I couldn’t wait until the end of the week to see her. I called her first thing Wednesday morning and she told me to come back to the clinic, but when I got there she was gone again, and she had the forms I needed to sign with her in her car, so I had to chase her around town all day. I finally met with her Wednesday afternoon and gave her the list of what I take so she could see what I was dealing with. She told me there was only 1 person on her entire staff that could fix my problem, and he would not be in town until Monday, so I would have to make it through the weekend on my own. Huh? I let her know that wasn’t acceptable because the insurance problem I was dealing with wasn’t my fault, SHE was the one who didn’t do her job and keep my paperwork up because I do everything they tell me to do when they tell me to do it, so she needed to at least give me some options about getting enough meds to make it through the weekend. I ended up at my pharmacy tossing out more than a grand to get a weekend’s worth of meds with the promise that all my problems would be fixed by Monday, and my (private) psychiatrist gave me all the samples he had in his office of the things I could not afford.

    Fast forward to Wednesday of this week. I had called my caseworker at least 20 times about my issues not being resolved and she didn’t call me back. I called her boss and least 10 times and she didn’t call me back either. When my caseworker finally got back to me she said she was sorry but she didn’t know when my problems would be fixed, so I would just have to wait. I reminded her that she had an entire clinic with a pharmacy AND a room full of samples that she could give me and she told me that wasn’t an option. Her boss said the same thing, and that it wasn’t their problem to deal with me. I told them more than once I would be out of medicine Friday morning and that I get sick without them. Sick like, I see and hear things and I am dangerous to myself and others in a very violent manner. I begged, pleaded, cried, yelled, and did everything else I knew to do. I was passed off to no less than a dozen people who told me to just go to the ER when I try to kill myself or get arrested and they will help me there.

    Why do I have to try and KILL myself or hurt somebody else before I can get the help they have right there in front of them? It’s not my fault I can’t get my meds at a real pharmacy. It’s not my fault my insurance hasn’t been fixed in 12 days. Ok, I’m done ranting. I’m just pissed that I have to get to this point. Grrrr.

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    Default Re: I'm sick and it's not my fault (Long rant)

    I'm not sure if its a national law, but, if you have a good prescription for medication, but, do not have the funds (I'm going off of Masshealth (Mass medicaid)), the pharmacy cannot with-hold your medication, however, they can "work-out" something with you until the issue is fixed.

    Overall I would been at their home waiting for them till they fix the damn situation they caused; nothing like state workers (sorry to any state workers here )

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    Default Re: I'm sick and it's not my fault (Long rant)

    why are you uninsurable (if it is not too personal)? i don't understand how being insured privately or publically works, since it seems to be kinda random overall.

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    Yekhefah
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    Default Re: I'm sick and it's not my fault (Long rant)

    That sounds exactly like Tenn-Care. I'm so sorry they're dragging you through this. I hope they resolve it!

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    Default Re: I'm sick and it's not my fault (Long rant)

    This is why I hate going to the shrink and taking meds. I am especially not very fond of public assistance. It's better here now that I am close to a big city but when I lived in a more rural area in SC it truly sucked. I remember I was having a severe panic attack because I was on the wrong medicine and the counselor asked me if I had a significant other and I said yes, why and she said well, you could have sex. Yeah, I am sure my husband at the time would find me real appealing when I was sweating, pacing the floor and basically felt like death was eminent. Or when they "try" you on various drugs and have very undesirable reactions and they tell you if you have a problem JUST go to the E.R. It's really hard finding good help. Some people honestly don't know how vunerable you feel when on these meds and will do just as little as they can get by then you end up stuck with the oonsequences.

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    Default Re: I'm sick and it's not my fault (Long rant)

    Quote Originally Posted by miabella View Post
    why are you uninsurable (if it is not too personal)? i don't understand how being insured privately or publically works, since it seems to be kinda random overall.
    I have a long psychiatric history that keeps private insurance companies from coming within 100 yards of me. Nobody wants the liability.

    Quote Originally Posted by Yekhefah View Post
    That sounds exactly like Tenn-Care. I'm so sorry they're dragging you through this. I hope they resolve it!
    Yeah, Tenncare has saved my life, but dammit at the moment they are making it pretty effing hard. The rules change so much that I can't keep up and the people that are supposed to help me find my way through it aren't exactly the smartest human beings on the planet.

    I had to argue with the doctor this afternoon about which medications I take that have generics because she didn't know. You're a damn psych doctor who is instructed to give out generics as much as possible, but you don't know which ones have them?

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    Moderator Djoser's Avatar
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    Default Re: I'm sick and it's not my fault (Long rant)

    Damn, Gingerlee, this sucks to hear about. Try to stay calm, and I sure hope things work out! We are here for you...
    You must have chaos within you to give birth to a dancing star.
    Friedrich Nietzsche

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    Senior Member mollywog's Avatar
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    Default Re: I'm sick and it's not my fault (Long rant)

    *hugs* Insurance stuff totally sucks. Good luck!

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    Default Re: I'm sick and it's not my fault (Long rant)

    Oh God I'm sorry. That is such utter bullshit. They have the meds you need, and they won't give them to you? WTF! I hope everything gets resolved asap gingerlee.

    I can't believe they told you to go to the ER if you try and kill yourself. That is so caring and helpful And to think they can completely prevent that from happening. Some people.

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    Veteran Member 423texas's Avatar
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    Default Re: I'm sick and it's not my fault (Long rant)

    Ginger,
    I'm the guy that told you that you are naturally funny, and you are. Hang in there and you'll get through this.

    A few years ago, I was treated for Hepatitis C. The main medication was interferon, and I also had to take something called Ribavarin. The medication costs were $12,000 a month! But I was lucky and had excellent insurance.

    If I may ask, what kind of medications (that you need) cost $1,000 for a weekends supply? My God, that's even more than the interferon that I needed.

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    Default Re: I'm sick and it's not my fault (Long rant)

    Quote Originally Posted by gingerlee View Post
    I have a long psychiatric history that keeps private insurance companies from coming within 100 yards of me. Nobody wants the liability.
    huh, i guess i thought in america money could buy any kind of care one needed, but apparently not.

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    Default Re: I'm sick and it's not my fault (Long rant)

    ^ Well, money can't buy insurance.

    Ginger, have you talked to a lawyer?



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    Default Re: I'm sick and it's not my fault (Long rant)

    I'm so sorry to hear all of this, Ginger. I went through a lot of medical fights also for my family...all the stress they put you through will MAKE you sick; you went through way, way too much here. I hope that you're doing okay, and want you to know that I'm ranting with you in spirit!
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    Default Re: I'm sick and it's not my fault (Long rant)

    I've gone through my whole house, looked in every possible place, and found a couple of pills. Not enough to make it through a weekend, but some are better than none I guess. Makes me kind of glad that I am a klutz who drops her meds once in a while.

    Quote Originally Posted by 423texas View Post
    If I may ask, what kind of medications (that you need) cost $1,000 for a weekends supply? My God, that's even more than the interferon that I needed.
    It's a combination of 9 different medications. It's sad that I take that many, but when I am on them I lead a pretty normal life, so I don't complain about throwing back 20+ pills a day to achieve that. Most of them don't have a generic option, and I take some seriously strong doses, which is why they are so expensive.

    Quote Originally Posted by Lena View Post
    Ginger, have you talked to a lawyer?
    I didn't go to one yesterday because I sat at the damn clinic all day, but if something isn't fixed by Monday morning, my boyfriend is probably going to drag me to a lawyer. My mom told him to do it because I'm not the one that messed up and it's not my fault that any of this is happening. I guess my mom has already called my caseworker and her boss and told them she is going to send me to a lawyer, because I got a message on my phone that I was being dropped from that 'team' and somebody new would be assigned to me that was better with legal knowledge at the beginning of the week.

  15. #15
    madmaxine
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    Default Re: I'm sick and it's not my fault (Long rant)



    It's cold comfort but most U.S. states' insurance coverage for your issue are often inept....I have learned by living with it. Gah.


    Hugs..oxooxoxoxoxoxox

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    Moderator Djoser's Avatar
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    Default Re: I'm sick and it's not my fault (Long rant)

    Could you try chopping the pills you found in half and taking half the dose you usually would? Just to get by, through the weekend?
    You must have chaos within you to give birth to a dancing star.
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    Free your mind, and your ass will follow.
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    Kaylinn
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    Default Re: I'm sick and it's not my fault (Long rant)

    OMG. This is terrible. I'm so sorry your going through this.

    If at a last resort....things get so bad that you would hurt yuorself...can you commit yourself to a mental ward of a hospital for just 2 days? To stay safe, to get your medication. Or have someoen stay with you 24 hours a day to make sur eyou stay safe, someone who knows how to handle the situation?


    If it is possible for you to half dose, just to get your through...maybe you won't be 100%...but at least somewhat normal?

    Can you search online for drugs from Mexico or Canada? Might not be the most legal thing...but when it comes down to hurting yourself or getting medication.....

    Along the illegal lines....anyone you know that takes yoru medication you can buy a few pills off? Definatly NOT safe and somethign I woudl never, ever recommend normally, but this is an exception I think. Just make sure you know they definatly take your drug in the right dose.


    God, it must be so incredibly scary for you to know that if you can't get your medication, your going to start seeing things and hallucinating. That's got to be so scary to know it's comming and there's nothgin you can do about it. Scary and frustrating as all hell. I'm sooo sorry.
    I wish there was something I could do.

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    Veteran Member Christian*Doll*'s Avatar
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    Default Re: I'm sick and it's not my fault (Long rant)

    if i didnt have my meds i would have seizures

    im so sorry that you have to go through this what a bunch of fucktards

    djoser has a good idea spread your meds thin
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    Default Re: I'm sick and it's not my fault (Long rant)

    Ginger you know I am a huge fan of yours - you are a strong and intelligent, beautiful person and it really, really upsets me that you have to go through this. That is the most fucked up and ridiculous thing I have ever heard. I dont know what I would do if this happened to me, I actually get physically ill - nausea and dizziness from the withdrawals from my anti-depressants/anxiety meds if I miss even one but the psychological withdrawal symptoms are even worse.

    I am actually sitting here furious about this. How can people not understand that the medication is vital to your health and wellbeing? To tell you if you feel like killing yourself go to the ER, whoever said that needs to be reported to their supervisor or someone in authority. That is a digusting and irresponsible attitude to have.

    I hope this is resolved asap for you sweetie.
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    Default Re: I'm sick and it's not my fault (Long rant)

    Call your local Senator, Town Representative, District leader...whoever.

    My FIL was having problems with his Medicaid paying his Social Security. By law, Medicaid HAS to pay SS out of the check and not give them money to the recipient. So, SS was not being paid because it was $1.30 MORE than what Medicaid was alotted to pay. So, SS would not accept Medicaid's check/payment. It was a big mess.

    I jumped online and emailed all of the offices that are in charge of my FIL's district. Every single one of them called back and offered to help. My FIL filled out the paperwork, sent it in to everyone and within 1 week, wouldn't you know that the problem was resolved?

    Utilize the people you put to work. Your state senator, your district rep, your attorney general, everyone. Sometimes it takes someone in office to grease the wheels.

    And, make sure you keep track of phone calls and letters that were sent. That caseworker is going to get her ass reamed...and for good reason.

    Good luck.

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    Default Re: I'm sick and it's not my fault (Long rant)

    Ugh, this is when I HATE insurance.

    Just because an insurance company isn't covering you anymore doesn't mean you're suddenly not sick. One would think it would be considered a LAW, that an insurance company cannot deny medical prescription support to a paying patient with a long to life term medical condition because of anything besides severe lack of payment.

    It's like fucking CPR. If you start to care for someone, you don't stop until the person can either care for themselves or someone equally qualified can take over. It bothers me so much that insurance companies are basically allowed to decide when/and how to disperse your money on a per issue basis as they see fit. I just wish there was a company that went with a "Get your help now, we'll figure this all out soon"

    IMO if GingerLee LIVES with this illness, both the pharmacist and the insurance company should have substantial records showing she takes/needs this medication and the medication itself should dictate the seriousness of it. The insurance company should have paid, and THEY should investigate the DOCTOR as to why the forms weren't filled out and THEN the patient if the Doctor proves faultless. Instead, Gingerlee, now in a growing-less-capable state is required to represent and fight for herself to be treated for an illness she has no control over.

    Nuts.

    Back to your regularly scheduled goofy Mast. This thread strikes a nerve.

    *Hands Gingerlee a wedge of cheese symbolizing our time together in 84* NEVER FORGET. Hope everything works out.
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    Featured Member snoopy's Avatar
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    Default Re: I'm sick and it's not my fault (Long rant)

    i second vg's suggestion. only do it in writing.

    i'm so sorry you're getting jerked around like this. classic example of the bureacracy screwing over the little guy.

    i like djoser suggestion too.

    but definitely start jotting down the history of this adventure to-date. it'll make for a very nice complaint and lawsuit. when you start sueing these idiot public servants personally ('cause they are personally responsible) i would think they'll be a little more responsible. that merry-go-round the caseworker gave you playing hide & seek at her office was ridiculous.

    maybe you should tell them, "please, i need my meds. the courts insisted i get them to avoid my homicidal urges. so please see what you can do. thanks!"

    the fuckers.

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    Default Re: I'm sick and it's not my fault (Long rant)

    Quote Originally Posted by gingerlee View Post
    Why do I have to try and KILL myself or hurt somebody else before I can get the help they have right there in front of them? It’s not my fault I can’t get my meds at a real pharmacy. It’s not my fault my insurance hasn’t been fixed in 12 days. Ok, I’m done ranting. I’m just pissed that I have to get to this point. Grrrr.
    Ginger:

    I've encountered parallel situations here in California with clients that have Medi-Cal. Sadly, many "civil" servants (like the caseworker you've described) move slower than glaciers do...

    The fact that you are medication compliant and have learned to refill your prescriptions well before your meds ever run out makes the "5150 scenario" (involuntary psychiatric hospitalization via the local ER) that was suggested to you particularly insulting. IMO, if you blew into the ER theatrically, the ER personnel and psychiatrist would reasonably assume that you DON'T keep up with your meds and DON'T care enough about yourself to do so. That, in turn, would likely impact the treatment you received while on inpatient psychiatric hold...

    If you pursue the legal angle or need to remind your caseworker of her obligations, here are some generalities:

    1) In 1998, Tennessee's Governor Sundquist signed mental health parity legislation to ensure that insurance policies cannot discriminate in providing treatment for mental illness. This legislation prohibits insurance policies in Tennessee from enforcing lifetime benefit caps or other restrictions for mental illnesses that are not enforced for physical illnesses and surgical procedures.

    2) TennCare also falls under the federal Mental Health Parity Act of 1996, but has recently undergone some internal changes in Middle Tennessee that may be affecting you:

    Mid-State TennCare Beneficiaries Could Have Limited Access to Physicians (03/28/07)
    Thousands of beneficiaries might be unable to receive necessary health services because the program's two new insurers have inadequate networks of providers, according to the , the reports...THCC also is concerned that the insurers have an incentive to deny care to beneficiaries, because the state pays a monthly payment per enrollee and insurers can keep what remains from that fee after providing care. Wilson said safeguards are in place to ensure that does not happen, and beneficiaries can appeal insurer decisions..."


    Quote Originally Posted by VenusGoddess View Post
    Call your local Senator, Town Representative, District leader...whoever...I jumped online and emailed all of the offices that are in charge of my FIL's district. Every single one of them called back and offered to help. My FIL filled out the paperwork, sent it in to everyone and within 1 week, wouldn't you know that the problem was resolved?...And, make sure you keep track of phone calls and letters that were sent. That caseworker is going to get her ass reamed...and for good reason...
    I'm feeling Venus Goddess. Regardless of the outcome, it sounds as though your caseworker was careless, and you deserve a better one

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    God/dess Lena's Avatar
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    Default Re: I'm sick and it's not my fault (Long rant)

    Yeah, I second VG's suggestion about calling a public official of some kind. Once when I was in foster care and they were screwing me over, I called the Governor. It worked real fast.



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    Default Re: I'm sick and it's not my fault (Long rant)

    trust me, here in Mass, a call to a local rep/senator/gov's office moves mountains, especially when it comes to healthcare.

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