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It’s another chance for me to get on my soapbox tonight, because I am once again frustrated with health insurance companies. Since when do they know more than doctors? My mom has been waiting for at least two months, to get the approval from her insurance company for an Alzheimer’s drug, Namenda. Her diabetes specialist and her internal medicine doctor both felt it was a good idea for her to be on it, but apparently her (high and mighty) insurance company knows better. The poor lady was given samples to take, to gradually work her way up in dosage, to see if she could tolerate the new medicine. (Aricept’s side effects were worse than death.) But Namenda worked well for her, and she and I both felt that we could detect that it was helping with her confusion. So immediately when the samples ran out, we took the prescription to be filled, and we were abruptly told that further insurance approval would be needed. We waited, and waited, and waited some more, to receive any word back from them, but none came. In the meantime, I had requested additional samples from the diabetes specialist, knowing that it was likely to be a long delay. Most drugs that work on the brain should not be stopped abruptly, and that is exactly what would have happened, if we waited on word from the insurance company. (As I expected, it was close to a couple of months before we heard, and then they finally wrote, informing us that the diagnosis of “mild Alzheimer’s” was not enough for approval.)

So she’s supposed to wait until it is no longer “mild”? (Apparently.) My understanding about dementia of any kind, is that the sooner you catch it, the better. You do not wait until it is full blown, and nothing can delay its progression.  She has 6 months to appeal, and they say they will not accept an appeal from her doctor. She is so fed up (and confused) that she would quit taking the medicine tomorrow, because of her disappointment and frustration with all the red tape required just to fill her prescription. I finally convinced her that it could be dangerous to stop it cold turkey, and that we need to check with the doctor, as to how best to taper off of it, without serious side effects.

So, once again, insurance companies get the last word. I wrote an article not long ago about a doctor who resorted to illegally prescribing a sleep aid to his patient’s husband, because the insurance company would not approve the prescription for her (as written.) He said many doctors are frustrated beyond words, because of insurance company interference. I am going to place a link to the article, because I think it goes along with this blog entry very well.

Is anyone out there running into the same problems with your medication, or a family member’s prescription? It’s a very frustrating predicament, and I feel that doctors, NOT insurance companies should have the final word, or perhaps we should all just start seeing insurance adjusters for our medical care, instead of doctors…

Please see other articles that I have written here:



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