Wednesday, January 27, 2010

Not good enough

I have often felt not good enough for many things - people, jobs, motherhood, etc. But I never felt my diarrhea wasn't good enough. Until today. I received this letter from my insurance company regarding the medication that Dr. GI wanted me to take. It simply states that I am just not pooping for the right reasons.

This letter is to inform you that we are unable to approve your physician's request for coverage of Sandostatin Ampul. The request did not meet the conditions necessary for coverage for the following reasons(s).

Coverage is provided for the treatment of acromegaly, chemotherapy-induced diarrhea, severe flushing associated with metastatic carcinoid tumors, diarrhea associated with vasoactive intestinal peptide-secreting tumors, sympotmatic tumors of the gastroenteropancreatic system (for example, insulinomas, glucogonomas, and gastrinomas (Zollinger-Ellison syndrome), and refractory HIV-related diarrhea.

Hmmmm. I guess having severe diarrhea 10 or more times a day just isn't what it used to be. When you get down to needing a medication because all other treatment has failed, you better need it for the right reasons - aka the reasons the insurance company feels you need it. Because we all know that the insurance companies sure know how to diagnose and treat patients. They know what's best. They also know that a medicine can never be used for a reason that isn't printed on the label. Thank God for insurance companies.

3 comments:

Kathryn said...

ARRGHHH!!! I am genuinely terrified healthcare reform will not pass. What's going to become of all of us? That's incredibly frustrating. Maybe your doctor can "code" it differently? Political posturing, big pharma, insurance companies...I've had enough! So sorry to hear about the the red tape you're facing.

Ragamuffin said...

seems like they figured out that if they covered everyone with Crohn's/Colitis diarrhea as well they'd make significantly less profit. i don't think insurance companies choose what they want to cover based on application of the drug in question, but on the frequency of incidence. how long would you have to wait for it to become generic?

項鍊 said...

Each to his own. 人各有志,加油! ....................................................