Wow, it must be magic.

My day began today with a phone call from the pharmacist at Walgreens. Let me start at the beginning. Yesterday evening I snuck out of the house (leaving children with dh) to embark on a wild mama's night out. I had to pick up a prescription. My youngest daughter, who is asthmatic, needed a refill on her medication. The medication she has been on for a month now has been an absolute miracle drug. Gone are the runny green noses, chest congestion, and croupy cough we had been battling every other week for a couple of months. When I arrived at the pharmacy counter (after perusing all of the holiday goods in a desperate search for chocolate covered cherries, which NOBODY seems to have) and told them my last name the response was "that'll be $163". I dropped my purse on the counter and gawked for a moment while I found my voice. I said "I'm sorry, that should be 'thank you, have a nice day'." You see, my children are on medicaid and prescriptions are usually free. The most I've ever paid is $1. I fussed and argued that there must be some mistake when, after much computer browsing, it is decided that I need "prior approval" for that medication. Not only is this news to me, but what the heck is a prescription if not "prior approval"??? Anyway, I attempt to call the insurance company and of course they're closed. I leave without the medication (after declining to pay out of pocket for them) furious that I am having to deal with this. AND, no chocolate covered cherries! So anyway, this morning the phone rings early and the pharmacist says that he's contacted the insurance company and I do, indeed, need prior approval, which he has faxed to the doctor's office. Unless I want to pay for just a couple (the price is $8 each if you are self pay) then I'll have to wait. I tried calling my doctor, who is out of town until Wednesday (now we're waiting almost a week without asthma medication, nice huh?) and the on call doctor cannot do anything for me since this is an issue that requires my doctor's input. I tried again to call the insurance company and again get the "we're closed" recording. So, livid, I call the pharmacist and ask who he spoke to because I can't get anyone. (Did I mention that the insurance company was off W, Th, Fr and normally off weekends so they had a 5-day vacation for THANKSGIVING where they were not available for any sort of problem resolution. I wanna work there!). The pharmacist, much to my surprise, gives me the number he called and instructs me how to get a human. I tell the nice girl on the phone the situation and she says "I'm sorry, your company handles their own prescription decisions. I don't have the authority to make any changes". All I want, at this point, is enough medication to keep my asthmatic baby out of the ER. Sorry, can't do it, blah, blah, blah. At this point the mama bear in me comes out. I say "Fine, then instead of getting the medication would you please consider this call my notice that I am going to the emergency room with my child". If you can, you're supposed to notify of the intent to visit the ER. I've never done it before but if they wanna play dirty, I'll play dirty, lol. She says "is this an emergency?" I say "well, it's not yet, but rather than waiting until the wee hours of the morning and needing to call an ambulance, I'll go ahead and go now. I've already spoken with my doctor and was instructed to go to the ER if I felt it was necessary. It seems rather silly that you'd rather pay a $500 ER bill than pay for medication but I don't see another option." Her response is "I understand, let me check one more thing, can I put you on hold?". She doesn't actually put me on hold so I can hear her clicking away at the computer. She comes back and says "ma'am, I don't know what the problem was, but it seems to be fixed now, it just went through." I made her call Walgreens for me to verify that and indeed it did just magically go through! Imagine that! I'm sure it had nothing to do with me threatening to make them pay 5 times more for an ER visit :wink:. Her last words to me were "you must have an angel watching over you". My thought was "uh, yeah, or I just found my inner b*#ch." The whole "prior approval" thing is a mystery still. At some point during the conversation it was mentioned that a specialist would need to be involved soon, that medications such as this are accepted more readily from specialists. My response was "we have an appointment in June of next year, the earliest they could get me in". I think I'll write my senator or something. Oh wait, he's the one cutting medicaid in the first place...