I Hate Health Insurance Companies!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I received a letter on Saturday from my health insurance company.  They have decided  not to approve my Humatrope.  This is a drug that is very important to me, because I have Adult Growth Hormone Deficiency.  The letter was signed by some dude named Mark Rubino, R.Ph, M.H.A..  He is the Chief Pharmacy Officer with Aetna Pharmacy Management.  Why can a pharmacist override the decisions and directions of a doctor?????????????  My doctor thinks I need the medicine!  My doctor went to Medical School.  Then she completed specialty training in endocrinology.  Did Mr. Rubino?  No, I think not!  I also went through a 4 hour L-dopa/Arginine test that proved that my body does not produce growth hormone.  I did not sit there for 4 hours having substances I.V.ed into my body, and having my blood drawn every 30 minutes for the fun of it!!!  @#!*%$#@  I did not undergo closed MRIs that lasted what seemed like forever to just entertain myself!  *&^%$#*@ Who are these people that make these arbitrary decisions about my health????? 

 I am sure they will get their bonuses for turning down patients who need help!  Michael Moore’s movie Sicko was right on target.  If you have not seen it, I highly recommend it. 

I feel right now that I am in a battle for my life.  I want to live a better quality of life, a normal life.  It has taken seven years to find answers to the problems causing the deterioration of my mental and physical health.  Now that I have a big part of that equation solved, I can’t get the medication anymore that was helping me work towards obtaining the life I once had, and the life I dreamed about.  The medication I need is Human Growth Hormone, and now with baseball players, and possibly other athletes misusing the drug, it is going to make it harder for people like me to obtain it.

I have a somewhat rare disorder called Adult Growth Hormone Deficiency.  What this means is that my pituitary gland does not produce Growth Hormone.  In adults, Growth Hormone Deficiency can cause the following list of problems:

• weakened heart muscle contraction and heart rate
• increased arterial plaque and blood pressure
• elevated lipids or fats in the blood:
 - cholesterol 
 - low density lipoproteins (LDL)
 - triglycerides
• decreased exercise capacity due to decreased cardiac output
• decreased energy due to decreased metabolic rate
• abnormal body composition:
 - increased abdominal obesity (waist to hip ratio)
 - decreased bone density due to decreased synthesis of bone
 - increase in fractures and osteoporosis
 - decreased muscle strength and muscle size
 - decreased lean body mass
 - increased fat mass
• low blood sugar:
 - dizziness or fainting
 - weakness or tiredness
 - headaches
 - poor concentration or memory
Physical Symptoms
 - lack of energy or fatigue
 - decreased sexual desire
 - muscle weakness
 - sleep problems
 - weight gain
Psychological Symptoms
 - shyness
 - withdrawal from others
 - nervousness or anxiety
 - problem with sleep quality
 - decreased social contact
 - sadness or depression
 - feelings of hopelessness
My Adult Growth Hormone Deficiency was caused either from some sort of head trauma (I had a very physically and sexually abusive childhood,) or from a prolactinoma or small pituitary tumor that has damaged my pituitary gland.  This has also reeked havoc with my hormones causing me to lactate (produce breast milk), and problems like having my period every two weeks.  It also might have caused my Hypothyroidism as well.  According to the Pituitary Network Association, 1 in 5 people have pituitary tumors.  In most cases they go undiagnosed unless a person develops some of the symptoms, and like in my case, once they start producing symptoms they can go misdiagnosed for years.

I went over 7 years battling the symptoms, going from specialist to specialist, and each doctor telling me to “just exercise and lose some weight,” which is hard for people with this disease to do because it causes enlargement of the heart, physical exertion intolerance, and causes your body to convert muscle to fat faster.  Doctors also told me that my symptoms were related to the sexual abuse I received as a child, or because I was on anti-depressants.  Depression, isolating behaviors, and apathy syndrome are also symptoms of my illness.  One endocrinologist, rated as one of the top in the Dallas area by D Magazine, without any testing looked at me, listened to my symptoms and simply told me quote “you are just too fat.  Exercise, lose some weight, or have a gastric bypass.” Endocrinologists are the specialists that are supposed to diagnose this problem!  All the while both my physical and mental health were declining.

It started for me at the peak of my professional career.  I had been working in Telcom/Technology for eight years, was making more then $80,000 dollars a year, and was looking forward to hopefully one day also having a family in addition to my career.  Back then I never dreamed I would be where I am now, alone, fighting a mental and physical illness that has destroyed my life and my body.  Without Humatrope, the Growth Hormone that I have been on, my life is not worth living!  I have been on the medication for about a year and a half and the improvement in my physical health has been tremendous!  I can now exercise, walk my dog, and even walk into the grocery store from a far parking spot without collapsing in exhaustion, all of which I used to not be able to do.

Now my new insurance carrier does not want to cover the drug, and even if they do the percentage I will have to pay will go up significantly.  Since this is a costly drug, it will be a struggle for me to afford it.  It is a catch 22 situation.  I want to have my life back, and the main drug that will help me to do this, I can not get!  I am at a loss for what to do, please help!

12 Responses to “I Hate Health Insurance Companies!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!”

  1. izzybella Says:

    Can you appeal it? I read somewhere that a high percentage of these types of refusals can be successfully appealed. Especially since you have a doctor who will verify that you NEED the drug.

    I would look on your health insurance’s website for appeals procedure. I will help any way I can!!!!

    That’s such bull. I’m totally on your side.

    How much is the drug per month?

  2. jehara Says:

    that is fucking horrible!!!!! who the hell do these people think they are?!!! i hope you can appeal the decision. you have been doing so much better these past couple of months since you got your medications sorted.
    motherfuckers.

  3. chauceriangirl Says:

    There has to be an appeals procedure at your insurance company–please look into it! I know your doctor will be on your side. Please keep us posted. I’ll send white light your way.

  4. izzybella Says:

    Me again-I talked to my monster and she told me insurance companies do this A LOT. They’ll deny a certain medication in the hopes you WON’T appeal it. Most people don’t. But 9 out of 10 times, if the doctor can prove it’s medically necessary and justify that it would be cheaper to put you on that medication overall (than hospitalizing you, etc.) then appeal is approved and you win. So do look into it.

    And you’re right. Health insurance companies suck.

  5. amethystd Says:

    Thanks for all of your advice! My Doctor, the drug company(Eli Lilly) and I are in the process of requesting an exception from the insurance company. I will keep you guys posted. thanks again.

  6. Dean Calvert Says:

    Good info. and reading. I would definitely bookmark you to check for new updates.
    Thanks,
    Dean

  7. Louie Says:

    Hi you can bypass your insurance co contact Lilly directly they have a program that can help. I am surprised your Dr hasn’t perused it. click this link.

    http://www.humatrope.com/reimbursement_services/index.jsp

  8. Joe Says:

    I know how you feel I have an anoxic brain injury I have been getting worse over the last 2yr
    I was doing real well after my injury. I was getting better real fast then I started getting real weak
    It happened real slowly I was able to walk 2hr a day on a treadmill and with my walker, I at one
    Point did not need my walker to go short distances like around the house or going into
    A restaurant. At this point its real bad I have to use my walker all the time if I go about 100ft
    I feel like I am going to collapse and if that is not bad enough I was stretching my back while
    Sitting in a chair and my back popped so hard I could not get up 911 was called they did a MRI
    They found 2 compression fractures in my back, how can this be I am a 38yr old male?
    I had surgery to repair them my surgeon said he has never seen this in someone my age he
    Did a biopsy of the bone he said the bone was real soft I have osteoporosis that’s just great
    I finally got an appointment with good neurologist he is a teaching professor he suspected my
    Pituitary got zapped in the injury another MRI confirmed it. I was referred to an endocrinologist
    He had me get a growth hormone stimulation test the test confirmed I am producing no GH at
    All he sent a request to my INS company for Genotrpin I got a letter saying that it was not
    A medical necessity how do you figure that I had to have a medical necessity to get the test?
    I had to file an appeal and now I have been waiting for a week. I finally found out what has
    Most likely been causing most of my problems now and I can’t get the medication, for god
    Sake I am disabled with a brain injury these people don’t care they aren’t suffering every day
    I bet if it were there family they would get their medication so fast your head would spin

  9. enke Says:

    Blueshield of California does this

  10. Anonymous Says:

    You should appeal. I hope you win.

    I can relate to your story, even though I wasn’t childhood GHD. My GHD was adult onset, and I saw many specialists before being diagnosed with empty sella syndrome.

    Taking HGH has changed my life for the better. The irony is that my insurance company spent 20x the money on me when I wasn’t on it, as I was going from one specialist to another, being diagnosed with erroneous conditions, and being put on inappropriate and expensive medications that had serious side effects, but did nothing to help me.

    My total cholesterol has dropped by 38%, triglycerides have gone from 500+ to 137, my energy level is way up, I am no longer depressed (after trying 7 different SSRIs that only gave me nasty side effects), and, well, I could go on and on.

    The ultimate irony is that the HGH costs about $240 per month at my dosage, and I will most likely never have to see another specialist for a diagnosis again, nor be put on expensive meds that did nothing for me, but which my health insurance company DID cover.

    So, they try to deny cost-effective and beneficial meds, but will approve inefficiently expensive and non-beneficial ones? What kind of business model is that, apart from the ethical and moral issues?

    I literally would love to be able to depose this Mr. Rubino, and anyone else who makes a decision to deny your claim. Justice is very sweet.

    If they deny your appeal, which you should definitely file, contact a COMPETENT ATTORNEY who has experience in these matters and who cares about your welfare.

    Please. Do that for yourself and your family.

  11. Heartburn Home Remedy Says:

    The topic is quite hot in the net at the moment. What do you pay attention to when choosing what to write ?

  12. Ted Burrett Says:

    Hey, cool tips. Perhaps I’ll buy a bottle of beer to the man from that chat who told me to visit your blog :)


Leave a Reply