Hello, I’m 26F and I am livid right now.
About 8-9 months ago I was diagnosed with severe cervical stenosis when I was just looking for an official diagnosis for the disability I’ve had my whole life. I was told that I need surgery because I have a really bad kyphotic curve in my neck and some of my discs are degenerating and putting pressure on my spinal cord.
I was also told that my bone density is shut and I need to be on a medication to strength my bones before surgery that has been advised to have done within the next 5-8 months.
I was prescribed a medication called Tymlos initially 4 months ago to address my bone density and I am expected to be on this medication for AT LEAST 3 months before surgery, but ideally 6 months to a year is preferred.
I’ve already lost 4 months with constant calls to my primary insurance, Accredo pharmacy, Medicaid, OptumRx and my endocrinologist.
Tymlos was denied and a prescription for Forteo was submitted.
Forteo was approved by Medicaid but Accredo pharmacy substituted the drug for something called Teriparatide without reaching out to my provider.
A new prior authorization was submitted to primary insurance for Forteo with notice that Medicaid approved their P.A.
Of course my primary insurance denies again but Accredo still needs more information because my primary denied but supposedly “didn’t specify why” which I think is unlikely because I was emailed an explanation for the denial.
Anyway, I’m mad and everyday for the last 4 months has been the most stressful I’ve ever been in my entire life.
I’m contemplating quitting my job so that I can get the medication I need to prepare me for this surgery.
I’m weaker than I was when I started physical therapy and occupational therapy nearly 7 months ago.
I don’t feel like it should be this complicated to approve. I shouldn’t fee like I need to quit my job because Medicaid alone is better than having the primary insurance through my employer halt the process of me accessing care.
About 8-9 months ago I was diagnosed with severe cervical stenosis when I was just looking for an official diagnosis for the disability I’ve had my whole life. I was told that I need surgery because I have a really bad kyphotic curve in my neck and some of my discs are degenerating and putting pressure on my spinal cord.
I was also told that my bone density is shut and I need to be on a medication to strength my bones before surgery that has been advised to have done within the next 5-8 months.
I was prescribed a medication called Tymlos initially 4 months ago to address my bone density and I am expected to be on this medication for AT LEAST 3 months before surgery, but ideally 6 months to a year is preferred.
I’ve already lost 4 months with constant calls to my primary insurance, Accredo pharmacy, Medicaid, OptumRx and my endocrinologist.
Tymlos was denied and a prescription for Forteo was submitted.
Forteo was approved by Medicaid but Accredo pharmacy substituted the drug for something called Teriparatide without reaching out to my provider.
A new prior authorization was submitted to primary insurance for Forteo with notice that Medicaid approved their P.A.
Of course my primary insurance denies again but Accredo still needs more information because my primary denied but supposedly “didn’t specify why” which I think is unlikely because I was emailed an explanation for the denial.
Anyway, I’m mad and everyday for the last 4 months has been the most stressful I’ve ever been in my entire life.
I’m contemplating quitting my job so that I can get the medication I need to prepare me for this surgery.
I’m weaker than I was when I started physical therapy and occupational therapy nearly 7 months ago.
I don’t feel like it should be this complicated to approve. I shouldn’t fee like I need to quit my job because Medicaid alone is better than having the primary insurance through my employer halt the process of me accessing care.