I got three pieces of mail from my insurance company this week.  One telling me I wasn’t approved for the Celebrex I finally got my doctor’s office to order.  Then came a letter saying I was approved for the MRI the neurologist ordered.  And finally, yesterday, I got a letter telling me I was approved, on appeal/resubmit, for Celebrex, for 5 days a month.  I’m allowed to be in pain 5 days a month.  Unfortunately, my uterus, hips, knees, and ankles seem to have other plans.

I’m wondering if the PCP’s nurse, who processed both the failed and resubmitted authorization, has a clear notion of why I take the celebrex.  I don’t think she does.  Well, it might be more accurate to say I hope that she doesn’t.  My initial request was not frantic.  My follow up, nearly a month later when my period was about to start and I discovered that the authorization still had not even been submitted, was.  And it focused on my period.  Which is very painful.  This may be where the “confusion” came in.  But I’m disappointed.  Disappointed that she processed the initial authorization late.  Disappointed that she processed it only as for menstrual pain.  Disappointed that she processed it as being because “nothing else works” and not because I have a history of upper GI complaints that spans over 20 years.  Disappointed that she didn’t take even 2 minutes to listen to why I take to much pain medication, even though it’s all over my chart.  I understand it’s a big chart, even just the history that was taken in their office.  But that is why the 2 minutes of listening would have helped.  I could have mentioned the chronic joint pain.  In my last call to her, the one to ask her to resubmit, she told me that the doctor usually orders an enteric coated naproxsomething or another.  I told her I tried that and that the EC really doesn’t seem to help much with the gut.  So she resubmitted.  She was rushed, I understood.  They’re busy, I didn’t want to eat into their time.  I figured we had it squared away.  I should have pushed.

Honestly, the joint pain doesn’t respond terribly well to Celebrex.  The Celebrex does not take it away.  But it’s better than nothing.  And it’s better than advil or the other non-selective NSAIDS in that I can take it and it helps some and it doesn’t eat up my stomach, which is chronically painful and problematic despite eating carefully and taking 20 mg of protonix twice a day.  Lately, i.e. since July when my Celebrex stopped, I’ve been taking a whole lot of Tylenol.  Which also helps some.  Again, not a great drug to take in big doses.  On the plus side, I don’t drink. Not a drop, so Tylenol is not the worst thing for me to take.

You’d think that it wouldn’t be so hard to get pain meds that aren’t narcotics, that aren’t addictive.  Instead, my insurance company has cut me off or made it difficult for me to get two of my non-addictive maintenance drugs and left me with the addictive options instead (last summer, it was “oh no, we don’t cover that anticholinergic that helps you not poop your brains out and pass out on the toilet…here, have some donnatol, with phenobarb!”)  And I have to say, I’m disappointed that my new PCP’s office seems to be less advocating for me than selling me out in this most recent round of stiff the patient.

I was really hoping for better.  I have another appointment with the PCP on Friday.  It’s late.  5:30.  Probably later since he runs late anyhow.  MRI at 2:00.  Haircut.  Doctor after.  We’ll have some things to talk about.  In the meantime, I’m going to hope for a change.  How I’ve been feeling is intolerable, physically.  And that’s making me feeling horrible emotionally.  And I really need to feel like I have help right now, not half assery.

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  1. I’m sorry to hear about your troubles with your insurance companies and doctor’s office. The entire system that we have to work/fight in is flawed. I hope that things get better for you soon. Blessings.

  2. It has been a really long time coming. Dammit! I know people are busy, offices understaffed, etc., etc. but sheesh. It’s not balanced. Just not right to struggle through more. Have to explain more. Have to push through more. This isn’t a second full-time job, it’s a sentence. At least with a job, you get to cash something in so to speak. I wish I knew the right things to say. I probably should. But right now, I just now I am pissed off at your body on behalf of you. I’m hoping for a big lift of physical symptoms so the emotional doesn’t give you that second clobber. That’s too much. Too much! I’m so sorry you’re going through such a rough time. It’s got to let up. It’s got to change. Time for your body to try a little tenderness.

    • I know. I’m really not happy about what feels like being left a bit high and dry. I honestly don’t know what she was thinking. I’m trying to decide if I should ask.

  3. R. G. Maines

     /  August 29, 2010

    Sorry to hear this. I can relate though. I talked to my doctor in March about the fact that the only pain med I’ve been prescribed doesn’t work and in fact, has terrible side effects for me. The side effects are almost as debilitating as the pain itself. I asked for a new pain medication… she said “let’s get the blood pressure and edema under control a bit first.” Okay… let me live in horrid pain for a while as we get these other things in order… seems reasonable… NOT!

    That was March, this is about to be September and still no pain medication. Her office, too, is terribly busy, she’s always at least an hour behind schedule and there are constantly new staff there, but come on! What ever happened to ‘do no harm’? I think when you let someone suffer in pain needlessly, that’s ‘doing harm’. That’s putting bureaucracy and ‘profit’ ahead of patient care.

    Again, I’m sorry you’re going through this. You’re not alone… maybe we can prop each other up while we endure the endless red-tape and seeming lack of understanding.

  4. Queen

     /  August 29, 2010

    Definitely think you should definitely ask.


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