A Sparkle and a Smile @asparkleandasmile - Tumblr Blog

karlvsn-deactivated20240312-dea

Just a random (and maybe drunk thought) on the healthcare system in America...

I won’t go into details but I have been struggling with a health condition for upwards of 10 years and finally a few months ago my Dr. prescribed a med that was new on the market. My insurance denied coverage which meant the out of pocket cost would be at least $1,200. My Dr. eventually found a mail order pharmacy where I could get it for $60 so that’s what I did.

The thing is, my Dr. could have stopped there. He didn’t.

At our next visit he told me he had written multiple letters to my insurance company asking they approve the med, but they either suggested 3 other meds (all of which we had already tried, and not only were they unsuccessful but posed greater health risks) or they just outright ignored his request.

I asked him why they kept denying it and with the saddest most disgusted look I’ve ever seen he said “It’s all about money.” He then explained while the med was performing extremely well it was still new and expensive to produce so they would rather deny it in place of more dangerous less effective meds.

He then went on to ask if I would sign a form giving him permission to advocate on my behalf. He wanted to file an appeal with the state against my insurance company.

As I was filling out the form, the woman at the front desk said. “We just did this process for this med with another patient and it worked.”Then she smiled and added, “he said you inspired him to do this.”

Y’ALL WHEN I SAY I TEARED UP SIGNING THAT DAMN FORM.

It makes me sad that this is the way our system currently works. But it also makes me really happy to know there are physicians out there willing to fight it. ❤️

We’re still currently in the appeals process, maybe I’ll update this post later with the progress 😊

asparkleandasmile

Just realized I never updated this!

After several appeals by my doctor my insurance company finally caved. I now pay $15 a month for a med that actually works and is safe for my body.

For the first time in over a decade my condition is under control and it’s all because I found a doctor willing to fight a broken system.

asparkleandasmile

Hi! Another update! This med is still proving to be both extremely effective and meanwhile while not impacting my health in a negative way. Multiple people in my life have confirmed this. However, me and my Doc are still consistently dodging the insurance company

asparkleandasmile

Here’s a 2025 update!

Not only does this med still work, I would say my quality of life has drastically improved during the several years I have taken it.

With that being said, the fight with insurance companies to cover this life altering med is still ongoing.

But the real reason I am coming back this post now is because I don’t think I fully explained how kick ass my Dr. is.

Remember when I asked him why the insurance wouldn’t cover the drug? He disgusted and rightfully said it was about money.

But he had also told me about another medication. I won’t name names, but it is used for a very popular condition and is on your T V ALL THE TIME now.

Now it’s the standard of care for that condition. But at the time it was new and controversial.

All the insurance companies were denying it.

He said Blue Cross in particular had a policy where the Dr. had to call in personally to prescribe the med.

They were deliberately making it as difficult as possible.

That did not slow my Dr. down in the slightest, and at one point a Blue Cross representative told him he had called over two hundred times for the same med.

The system IS broken.

But not all that work in it are broken too.

#my text #healthcare #american healthcare #rant #drunk thoughts

taros

https://www.instagram.com/p/CkveBZcBkRD

the-photograph

igmakeup

v77e-deactivated20250622

asparkleandasmile

Just a random (and maybe drunk thought) on the healthcare system in America...

I won’t go into details but I have been struggling with a health condition for upwards of 10 years and finally a few months ago my Dr. prescribed a med that was new on the market. My insurance denied coverage which meant the out of pocket cost would be at least $1,200. My Dr. eventually found a mail order pharmacy where I could get it for $60 so that’s what I did.

The thing is, my Dr. could have stopped there. He didn’t.

At our next visit he told me he had written multiple letters to my insurance company asking they approve the med, but they either suggested 3 other meds (all of which we had already tried, and not only were they unsuccessful but posed greater health risks) or they just outright ignored his request.

I asked him why they kept denying it and with the saddest most disgusted look I’ve ever seen he said “It’s all about money.” He then explained while the med was performing extremely well it was still new and expensive to produce so they would rather deny it in place of more dangerous less effective meds.

He then went on to ask if I would sign a form giving him permission to advocate on my behalf. He wanted to file an appeal with the state against my insurance company.

As I was filling out the form, the woman at the front desk said. “We just did this process for this med with another patient and it worked.”Then she smiled and added, “he said you inspired him to do this.”

Y’ALL WHEN I SAY I TEARED UP SIGNING THAT DAMN FORM.

It makes me sad that this is the way our system currently works. But it also makes me really happy to know there are physicians out there willing to fight it. ❤️

We’re still currently in the appeals process, maybe I’ll update this post later with the progress 😊

asparkleandasmile

Just realized I never updated this!

After several appeals by my doctor my insurance company finally caved. I now pay $15 a month for a med that actually works and is safe for my body.

For the first time in over a decade my condition is under control and it’s all because I found a doctor willing to fight a broken system.

asparkleandasmile

Hi! Another update! This med is still proving to be both extremely effective and meanwhile while not impacting my health in a negative way. Multiple people in my life have confirmed this. However, me and my Doc are still consistently dodging the insurance company