I am so furious with my insurance company! This is a rant, and it may be long. First of all our insurance is through my husband's former job. When I retired a year ago, we dropped my insurance and went back on his, because it was cheaper. He worked in WI and we now live in IL. I really need to find a counselor. I've had minor depression and been on low grade anti-depressants for years. Now I need someone to talk to - mostly about my concerns about his diagnosis. I have been fighting with the insurance company about paying for someone for about six months. They have very peculiar requirements about who they will pay. These requirements may make sense in WI (who knows), but they don't in IL. Either the psychologist has to be part of a medical clinic and bill through the clinic (a clinic on their preferred provider list) and also be on the preferred provider list or the psychologist has to belong to one of two organizations and be on the preferred provider list. According to a psychologist I know, the only thing you have to do to be on the lists (in addition to being a licensed psychologist) is pay $300 dues every year, so not many people join. There are only two members within 50 miles of us. One of them is a close friend, and I don't want to go to him. Every time I call the insurance company and ask about whom I can see, I get a different person who gives me a different list of names. I have talked to five or six different people in the last two days and who knows how many before that. A couple of weeks ago, "Jasmine" told me I could go to a specific clinic and see either Dr. W. or Dr. K., both of whom were women (which I wanted). I made an appointment and saw Dr. W. yesterday. I liked her very much. The billing clerk at the clinic called the insurance company and talked to Alan. He said they wouldn't pay anyone at that clinic. When I got home, I called ins. and talked to Maribeth. She said she would check and call me back. I had to go to a meeting, and when I got home, I had a message from Vickie L. at the ins. co. saying they would not pay Dr. W., but they would pay Dr. K. or Dr. H. at the same clinic. According to the clinic's flyer, Dr. H. specializes in gay & lesbian issues and sexual offenders - not what I need. I called back, and got Jasmine. She tried to transfer me to Vickie, but Vickie wasn't available, so I left a message. She hadn't called back, by 1:00 today, so I called again and left another message (after talking at length to another Vickie). At 3:00 I called again and got Valerie. Valerie did a lot of checking, talked to her supervisor, and called the clinic here, and finally told me that Dr. W. was covered. After I hung up, Vickie L. called, returning my calls, and said Dr. W. was not covered. At this point, my husband got on another phone and yelled and swore at Vickie. I got him to hang up and talked to Vickie. She was upset and told me she would check again, but she wouldn't call back, because she was not going to be sworn at. I asked if she saw why I needed a psychologist and told her that if my husband answered the phone, he would swear at whomever called and at me.
Help! The insurance is through the University of Wisconsin-System. When I call the ombudsman there, she says to talk to the insurance company. When I talk to the insurance company, they say the UW-System made up the stupid rules. I need to write to someone or call someone higher up somewhere, buy I don't know who. I'm about ready to get in touch with the senators and governor from Wisconsin - either that or check into a mental hospital and see what they do about paying for it! I am really fed up. Any thoughts?
Suggestions: 1. Somewhere (online or in writing) there should exist a list of covered providers. Get a copy of that list. 2. Pick your provider from that list and call the insurance company and ask for a letter or an email to print off preauthorizing services from that provider. 3. If you have any problems when you call the insurance company ask to speak to the supervisor in charge of preauthorizations. Usually the first person who answers the phone in that department is very low on the hierarchy and their position simply requires that they look at a list and say "yes" or "no". If they don't know two lists exist, or they don't know how to work their computer well, or the company is poorly organized, or people are just lazy or in a bad mood - you'll get two different answers every time. Ask the supervisor to send you a letter authorizing you to see Dr. W. 4. If they continue to be ornery/ignorant, contact your state board of insurance and file a complaint describing the details of the problem. Here in my state, they assured me they would act on any complaint received within 10 days. I was able to file the complaint online thru my state government's website. 5. Another option - if you've found a provider you like and your insurance company still says she's not on their provider panel, ask for a single case contract. They will send the provider a letter for her to sign accepting their reimbursement level effectively making her a provider for them just for you. 6. Another option - ask what your out-of-network benefits are and then decide from there: Dr. W may be willing to accept your out-of-network benefits and negotiate a copay for you; or she may be able to see you without benefit of insurance and negotiate a payment plan for you.
Thanks for the suggestions. I've tried most of these, except for filing with the state board of insurance. I didn't know about that. The out of network idea doesn't work, because the insurance company won't even pay out-of-network benefits unless the provider belongs to one of the two organizations. Anyway, after another call this morning, I think I'm making progress. I'll let you know what happens.
I have a question about Tylenol PM for myself. If I take a Tylenol PM it helps me sleeping and I don't have sleepiness the next day. If I take a benedryl, it also helps me sleep, BUT I feel doped up the next day. This makes no sense. Has anyone else experienced this or is it just me being weird.
Is benedryl what is in Tylenol PM? Or is it some other drug?
I've never taken that particular drug, so I can't answer your main question, but you might want to look at the ingredient list. And if it is benedryl, how much? Is the amount you would be taking different?
Me, too, lmohr. I prefer Excedrin pm but for some reason it's hard to find around here so I take some generic sleep aid and then an aricept - I have a bum knee that wakes me up hurting. I don't want to get to the prescription meds until/unless these don't work any more, but benedryl really knocks me out.
Starling - 1 tylenol PM has the equivilant of 1 benedril in it and nothing else. briegull, why are you taking aricept? Does it help you sleep? I also take a .25 mg. Xanax and those two work pretty good but sometimes I wake 4 hours later when I suppose the tylenol PM is wearing off.
Actually they worked better for mine than anything else I had tried. I was on Vioxx for 18 months until they took it off the market. We tried a couple of other kinds of drugs with no success and I suggested that we attempt Alive because we had never tried any amount of Naproxen. So I tried double the over the counter dosage with my doctor's blessing. The lowest prescription strength is higher than that. And it worked.
At one point I was taking 4 Advil at a time (every 4 hours) plus 2 Extra Strength Tylenol 2 hours after the Advil and I was still in pain, which is why they put me on the Vioxx. Alieve worked just as well.
It is amazing what minor knee surgery can do for you. I'm totally off pain killers at this point. The only other thing that changed was the fish oil.
The orthopedic surgeon put me on fish oil BEFORE the surgery. He said wait 2 weeks and start dropping off one pill at a time. I was on one Aleve twice a day BEFORE the surgery. After the surgery I did the same thing. One pill less at night. A few days later one pill less in the morning. Then I gave up the last morning pill and finally the night pill.
Fish oil lowers inflammation. It works on joints as well as the heart. That practice was putting all of their patients (and the doctors as well!) on fish oil to help get them off the pain pills. Worked for me.
I am using Coromega. It is a weird product that comes in packets and tastes something like a pudding. That is the consistency. One packet is the equivalent of 1 teaspoon of fish oil. I'm not having problems with it.
I also didn't have problems with the oil liquid, but hated the kind that was emulsified. I understand that sometimes people have problems with digesting the capsules because they use a lower quality of fish oil in it. The difference is if it is Pharmaceutical Grade, which this product is. And the oils I used before this were also Pharmaceutical Grade.
On the box it claims that you can absorb this product better than capsules. There is some egg yolk in this product, so if eggs are a problem you need to be careful, but remember that one of the best Omega 3 sources is egg yolk, so it is there not just to make the product taste better but to provide an additional source of Omega 3. The primary ingredient is fish oil and the second is water.
Starling, I am using the Coromega, too. It doesn't taste bad at all....I usually put it into some yogurt but I have tasted it and it doesn't taste fishy at all, kind of citrusy......Those fish oil capsules are so big I thought I would try the packets and I am glad I did.
I just do it straight, but my son-in-law's mother puts it into smoothies for her 90+ mother. The stuff doesn't need refrigeration so it is great for a place like Honduras where you can't count on electricity. At this point both of them are using the stuff too, and my SIL's grandmother no longer needs the heavy pain pills they couldn't get for her on a regular basis.
It is really good stuff for aching joints. And the side effects are good for you - lowered cholesterol, better heart.
I have been taking Omega-3 capsules for over two years now. I get it on line, and it is by Sealogix. It also is pharmaceutical grade...four a day. I have never had an after taste or any difficulty swallowing them, and I can't say that abut most larger pills or capsules.This stuff has totally saved me. My arthritis was so dreadful, I couldn't walk for any distance at all, and I wore braces on both hands. I easily walk any distance and threw away the braces . It is miracle stuff for me!
I think the key is pharmaceutical grade. I don't think it matters how it is packaged. I have so many problems with pills that I originally went with the liquid. Pharmaceutical grade oil has no taste except for a little citrus taste they add in for some reason. But the key seems to be the grade of oil that is taken, no matter how you take it. It is lovely that there are at least 3 good ways to do this because one of them will fit almost everyone.
And remember that when I started taking the fish oil, I was using a cane and had been using one for years. And had only recently worked up to putting the walker away at night. I did not have knee replacements. Just some clean up in one knee and multiple shots in the other one as long as I was asleep. It has been more than two years since the surgery.
I take one packet a day. When I was doing liquid I took one teaspoon a day. The doctor who put me on the stuff suggested two teaspoons to start, and I did that. If I've got any pain, I go on two packets until I don't have the problem anymore.
I'm not sure how many capsules that is because I never took that kind. Kathi says she takes four capsules a day. This is basically a food. So it is OK to take a bit more to begin. The box or bottle should indicate what a normal dose is.
Janet, have you considered widening your search to a licensed social worker or psychiatrist? Just a thought. Hope you can get that mess straightened out. Usually the insurance company gives you a provider list of people approved for their network, have you asked for that?
Kitty, thanks for the suggestions. The insurance company will pay only a psychologist. I do have a list of preferred providers. The unfortunate thing is that the first thing that is said when I call is that payment cannot be guaranteed, because payment depends on eligibility at the time you see the doctor. They cover all bases - and this is probably the biggest insurer in Wisconsin! I think it's settled now, and that they will pay the person I saw last week. I have another appointment with her Tuesday. It's fortunate, because after worrying about the economy all week, I engaged in a little of that retail therapy this afternoon. That cost more than the therapist would.