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HIV Life >> Living With HIV

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TimmerInTexas
Newbie

Reged: 08/24/05
Posts: 1
There's Health Insurance and then there's....
      #159073 - 08/24/05 10:08 PM

Secure Horizons -- what a joke!

Since I'm covered by Medicare Parts A and B, I discovered that I qualified for health insurance through Secure Horizons, a subsidiary of PacifiCare. I have 17 prescriptions that have to be filled every month so I thought Secure Horizons was a godsend since there wasn't a monthly premium other than the amount previously deducted for Medicare from my monthly Social Security disability check.

Little did I know that only 5 of my prescriptions would be approved by Secure Horizons' pharmacy, and that was probably only because 3 of the 5 are HIV drugs that an HMO can't deny. However, Secure Horizons DENIED my prescription for Fuzeon because it was being self-administered -- according to their guidelines, I would have to go to a doctor's office every 12 hours to get my Fuzeon injection. It didn't matter to the pharmacist that there aren't any doctors who have office hours that cover a 12-hour period or are open 365 days a year. It didn't matter to the pharmacist that I've been self-administering Fuzeon injections for nearly 2 years. It didn't matter that even if I could find a medical office that was open for 12 hours a day, 365 days a year that this would revoke my independence and subject me to a schedule that would prohibit trips, interfere with my schedule and make my $2,000 Biojector unit gather dust.

Another prescription that was denied was for OxyContin, a potent narcotic that relieves the constant pain from chronic neuropathy. I have grown dependent on OxyContin for nearly 3 years, but now I've been cut-off cold by Secure Horizons. That means that when I take my last dose of OxyContin I will go through withdrawal as bad as any junkie on illegal narcotics. I'm afraid to even count how many days of grace I have left from my remaining stash.

That old adage about "You get what you paid for" sure is true! I paid nothing for Secure Horizons and I'm getting almost nothing in prescription coverage. For the first time in 13 years, I'm feeling like the future looks pretty bleak.

If you have the opportunity to sign up with Secure Horizons -- think twice!! You might be better off WITHOUT this HMO screwing up your life.

TimmerInTexas

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debtex
Legend

Reged: 03/21/05
Posts: 846
Re: There's Health Insurance and then there's.... new
      #159079 - 08/24/05 10:57 PM

Wow, I am so sorry to hear aobut this!! I hate to hear such difficulty with such supllies needed to keep you living as you should. How is your doctors office? Can they be pretty flexible? I know we have a few patients at our clinic that have the prescriptions sent directly to us.....and we will fedex (or mail) the medication to the patient for them to administer. (of course will strict instructions for the first 2 or so weeks, probably coming in daily for that). but then like I said....we get it, and we send it. and make sure they atleast follow up if not weekly, then biweekly. Do you think your doctor would be willing to do that? sometimes some of the major hiv clinics are more understanding about stuff like that.

and I hate to hear that you cant get the proper pain medications which your body has grown so used to needing. I hate to say, but maybe it will make it a little less tough on you.......would something else for a pain killer be an option? What about neurontin??

I really wish you all the best. Some insurance companies do truly suck.

all my prayers,
deb

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_tylox99_
Regular

Reged: 07/14/05
Posts: 38
Loc: MA
Re: There's Health Insurance and then there's.... new
      #159160 - 08/26/05 12:00 PM

I just wanted to say that's awful, and Ive heard Secure Horizons may be switching some people to MedciareD so hopefully it may get better.

But it was not the decision of the pharmacist you dealt with at the retail level. I see, every day, people who have prescriptions that are not covered by their insurance. It is the decision (even though it is an extrememly stupid decision) of the insurance. The pharmacist literally has ZERO control over that situation.

The MD may be able to call the insurance for a Prior Authorization. They should speak to the clinical department. It is, obviously, a bad decision made by the insurance. Possibly they don't understand about Fuzeon injections?
You could also call your insurance to see what steps are needed to take to get this medication covered

But please, don't blame the pharmacist, they had no control over this

--------------------
Words are, of course, the most potent drug used by mankind.

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Monchhichi
Guru

Reged: 02/07/05
Posts: 248
Loc: Florida
Re: There's Health Insurance and then there's.... new
      #159199 - 08/27/05 09:03 PM

There has to be a way to bypass that like Deb said. Fuzeon is meant to be a self adinistering drug. I know me and my husband were given a lesson at the doctors office where I made my first shot on him. We have been to a dinner hosted by Roche which manufactures the medication. The company cares very much about the effectiveness of their medication. We have never had any problem. Do you qualify for Medicaid? They should cover that. Or ADAP maybe? I know the withdrawl to Percocet is going to be brutal yet There has to be a way to bypass. Talk to your doctor. Call Roche and see if they can donate a starter kit for you so that you can at least have 1 month supply while you battle. BE PREPARED TO BATTLE. Never give up and you will get what you want. If you are qualifying for Medicare than you should be able to qualify for so much more. Cancel that bullshit insurance and try to get help elsewhere. Good luck!!!

--------------------
Never forget: Life is too precious to take for granted.


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