The Conclusion

Half-Way Fixed

My debacle with Medi-Cal Blue Cross has ended and my problem fixed is halfway fixed. Half-way meaning that I managed to access ten pills of 10 mg Escitalopram and my prior authorization is underway. For those unfamiliar with the United States healthcare system, prior authorization is a requirement that a physician obtains approval from a health insurance plan to prescribe a specific medication for a patient. In my case since Escitalopram is not covered by Blue Cross, my psychiatrist had to do a prior authorization to present the case that I need this particular medication and no other medication will do. According to Mr. Squigglekins, my lovely pharmacist quasband, PA’s are annoying to deal with it because it takes time to do and insurances don’t want to pay for medication that’s out of their network. I managed to buy ten pills of Escitalopram because my psychiatrist faxed a new prescription to the pharmacy where I will now be receiving my medications. Fortunately, my psychiatrist will be seeing me next week and my prior authorization for a full 30 day prescription of Escitalopram will be approved.

This experience with Medi-CAL has taught me many hard lessons that I despised going through, but now am appreciative.

First Lesson:

When you see your medication is diminishing-say ten pills- go to your pharmacy and have it refilled. It’s good to have this habit because if you run out, at least it’s there and you’re not scrambling to have it refilled. Also, you can have a journey like me and suddenly have no access to it.

Second Lesson:

You have to be your own advocate for your health, especially when you’re on Medi-Cal or other cheaper medical insurances. Even though in the pamphlets insurances write they put their patients first with smiling people on the front, its bullshit. Call your clinics, insurances, and pharmacies and be assertive with your needs. Demand it. Unfortunately, you have to push their shit in order for them to notice you. This is medical insurance for the masses, I’m just a number and you’re just a number to insurance.

Third lesson:

Research the pharmacies and medications that are part of your medical insurance’s network. Yes, it’s supposed to be insurance that does the calling and research part, but there are so many people they deal with, you’re most likely going to be overlooked or forgotten. An example is that I had to stop going to Walgreens, a pharmacy I’ve gone to for most of my life because it’s not part of Blue Cross’s network. Another example is my medication, escitalopram. Blue Cross doesn’t cover it but if my prior authorization gets approved, then I can have my full supply.

Fourth Lesson:

Find people who can help you. I’m really lucky because Mr. Squigglekins is in pharmacy school and understands the technicalities of medical insurance and how pharmacies handle it.  I can thank my therapist enough; she was there for me and called my psychiatrist that I needed a prior authorization so I can have my medication. If you feel like you don’t have those people, look for the number for your local mental health clinic, if you call and push enough, you’ll get through to someone.

Fifth Lesson:

It’s going to be alright. Going through this experience, it was hell. I had a breakdown on my way going to my local mental health urgent care center to see if I was able to receive a prescription for my medication. (It didn’t happen and I left the center frustrated) While driving, I screamed and honked at random drivers. Yes, it’s inappropriate, but I was pissed, this is something that I needed to help me with daily living.

The U.S. healthcare system

Yes, the United States healthcare system is broken, but I try to see the good from the bad. I’m fortunate I had the time and access to run to different pharmacies and call people, others don’t have that. I’m thankful for Mr. Squigglekins and my therapist for guiding me. Last, I’m grateful that this experience has taught me more about the U.S. healthcare system than what I knew before.

By Jd5466 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

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