i have been in such pain for the last couple of weeks due to the weather. i have been fighting to get out of bed every morning as everything just seems so pointless. i missed my shrink appointment today. i forgot about it. No big loss. 50 minutes to get there, 50 minutes back, and the session is eight fucking minutes. The sun was supposed to come out today, it never did. i was hoping to get some single track time in but the weather sucked for it.
i have HIV. Through good fortune NYS ADAP pays my health insurance premiums. All good. i have had Oxford for a while with no issues. In Nov they changed their pharmacy plan, i was suspicious, but i still got my meds locally all is well. Dec i filed the forms for the new plan since my old plan was canceled. i sent the forms into NYS Department Of Health, who pays the bills, they Ok'd them then sent Oxford a payment. the first week in Jan i got a call from them as i checked the wrong box on the form. i was only eligible for a HMO as opposed to a POS. i really didn't care as either one works for me.
My meds were up for refills. i hand not received my insurance cards yet, so i called Oxford and got my new membership number to refill my meds (luckily i have a few months of the hiv meds stocked up but not others). Let the fun begin!
1- Call from pharmacy, there is an insurance issue. They needed my insurance number, issue solved.
2- Call from Pharmacy, some medications now need pre-approval, others are on hold i have to call the insurance company.
3- Call Oxforrd get number for Pharmacy Company. i asked if this is mail order, she said she thinks so for "specialty" medications.
4- Call Pharm Company, she needed information to transfer (!) my scripts. At this point i asked more questions and found out they are mail order. My Dr. hates mail order and its not great for criritcal meds. They recommend calling Oxford to try to get a waiver.
5- Call Oxford (Customer rep was really nice so this was all friendly conversation with people). Asked about a waver and explained my HIV meds. One hadnt appeared on thier system yet which was worrying but it did by the end of the phone call. She was surprised that for critical meds (i played that up) that it had to be through mail order. We filed an appeal to be able to get them where i have been getting them for over ten years. Rep said i would get a confirmation letter in 5 days and a decision in 30 (!). Imagine if i didnt have three months of meds stocked up.
For the fuck of it i googled "New York State Mail Order Pharmacy". Much to my surprise in 2011 a law was passed that a NY insured can not be forced to use a mail order pharmacy. It was modified for medicare but not private insurance.
6- Call oxford back, modified the appeal. Still have to wait 30 (!) days for a decision.
7- Call NYS DOH and see what they can do about this, if they even know about it.
i am exhausted and drained.
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