Me Next

[Bobbie]

Well, I was just turned down (second appeal) on Forteo - for my osteoporosis. This has been going on for months. Da...m. I've taken it before (a contraindication) and I have a small kidney stone. Saw my uro. yesterday and he was very supportive. He said, "Call your osteo doc. back and get him going on another appeal."

"They" (the authorities that be) think C. diff. contributed to my osteo because of mal absorption. However, I am the ultimate poster person for osteo - Nordic background, blue eyes, small frame. My mother died after her second broken hip (she had osteopenia). My g. mother had her first broken hip at my current age. My paternal g. mother and 2 of my p. aunts (and a cousin) had osteo. I've been on prednisone a number of times when I had asthma and pneumonia and was on a steroid inhaler for four years for asthma. I've broken a vertebra and my left wrist.

There is no way I could exercise more - Jazz. 3 to 4 X a week, zumba once a week, lots of walking. Enough calcium and Vit. D. Was on Actonel for years until I had a reaction and then a nasal spray that didn't do any good.

The woman from our secondary insurance co. called me today said the pharm. co. turned me down because the literature showed Forteo could make me worse. I don't believe it. I said I would sign waivers, etc. but I WANT that med. It is the only thing left for me to try, and it helped me the first time. If I don't get some type of coverage, the medicine will cost $l,700.l6 every 28 days for 2 years.

And, Sarah, when I started to cry after the phone call telling me the 2nd appeal was denied, I started to cry (I seldom cry - no tears left) my husband yelled at me. The jerk!!!!!!! So I yelled back.

It's too bad we can't get together for a pity party. I am leaving for book club where I will have to watch where I sit because half the people come with all kinds of resp. crud.

I read the book years ago, "Why Bad Things Happen to Good People." Maybe I should reread
it.

Da.... Da.... Double Da.... Perhaps we should review the rule about no profanity on the site?

Good luck to everyone on the site who is having health issues plus C. diff. Remember, perseverance counts! Don't give up. I will get that medication someway!

[saraht]

Ah, Bobbie I'm sorry to hear you were denied again! I don't understand these insurance companies. If you can't get the medicine you need, what are they here for? And I also don't understand why some medications have to be so darn expensive!
I think there is so much that needs to change in this country. Nothing like having the medicine right there and not being able to get it. If they don't consider you a poster child for the med then I don't know who would be.
Glad to hear you are so active though! I just bought Zumba last week, was learning the moves and did the quick start it came with, now I'm too ill to do it. I've only got to do it once but I really enjoyed it.

Yes we need to get together and let our husband do what they do. I'm refraining from calling him by his second name, the "a word" I don't understand men. I was sitting here crying and he's just getting more mad and yelling. If I ever made him cry or seen something that made him cry, I would probably cry too. Typical. How soon will you file the appeal, and how long does it take to get an answer? Let's pray third times a charm! They can't say no forever!!! Praying this next time is the trick!

[Bobbie]

Thanks, Sarah,
I have a call in to my osteo. doctor's nurse. This will be my third appeal. it will take up to a month to get a final answer. I was on Forteo again for 3 months - without a problem. When our mail order med.companychanged, the 2nd company discovered the "double use." The first company was fine with it (or didn't notice it) and my doc. recommended it. He said he had only two patients worse than I am and they are back on Forteo. He said there is nothing in the literature that showed a greater incidence of bone cancer with a second use.

Hope you are feeling better. When his your daughter's party? lst or 2nd Bday? What is the theme of the party? Does she like My Little Pony or is she too young? (Trying to remember what my grandkids liked altho. they live in the UK.)

You've been through a lot - C. diff. while pregnant, childbirth, and still not feeling well, but you are always there for others.

Ignore your husband for awhile. Maybe he'll "get the picture."

Do you live close to any of the docs. listed in our Doctors forum in case you want a 2nd opinion?

[abnova]

I know Im new here but I just wanted to jump in and say that YES we should be allowed profanity when it comes to insurance lol.

But really, I hope you are able to work it out. It really does sound like you need that med. And why does the ins company think they know more about your condition and what is good for you than your own Dr anyway?!

I will have to look into that book you mentioned, I've been wondering that myself the past few months with being diagnosed with Lyme and now this. Was it a good read? Did it help you?

[saraht]

Thanks Bobbie, I appreciate the kind words. Still feeling terrible, lots of random fibro pain going on right now, and lots of back pain. I don't know if its from IBS, Fibro, c.diff relapse, or something else. I feel crazy with all these symptoms. Could be fibro is acting up from whatever else is going on. I took a nap today when my daughter did. I just feel so run down, tired, ill, weak, achy, anxious, depressed. Is there a cure for that? Praying the blood work gives me some kind of answers.

My daughter is turning two in April. I was getting her invitations ready for her party to send them out. I love crafts, so of course I had to do something crafty. She is really into Mickey and Minnie so she is having a Minnie themed party. I'll message you a link to a picture of her in her "Minnie dress" I decided last year for her first birthday that every birthday I'm going to buy her a dress that fits the theme of her party. Last year she loved Rapunzel from Tangled.

How is your husband acting?? Mine just left for work, when he woke up he came down stairs and asked how I was feeling.. Shocker! So you where on this med before and the insurance covered it then and don't now? Hopefully it won't take that long to get an answer this time around. I want to meet the person that makes these decisions, and I want to know what their yearly figures are.

[beth22]

My husband yells too. Men can't deal when we are sick. Fibromyalgia goes hand in hand with IBS and especially IBD and SIBO. Be re-checked for c diff first, and then go from there is you are negative. They have tests for Crohn's and SIBO as well.

[seekingcure]

Well, we all know with insurance companies it's all about the bottom line. If they can get by with denying an expensive medication, they will. And, of course, many of the medications themselves are overpriced. Medication prices are so inflated that for many of us, Medicare part D coverage runs out early in the year, and doesn't pay anything else until we've spent $4550 out of pocket. Even one prescription of Dificid would more than put one into the donut hole. Unfortunately for too many seniors, it becomes a choice of having all the medications they need or eating and staying warm.

Bobbie, keep fighting the bureaucracy until you win! We're all rooting for you.

[seekingcure]

By the way, apparently all our husbands are the same way. Mine doesn't like to hear me complain either, but you let him get a little cold and you'd think he was dying. He's not even able to get out of bed to fix himself a can of chicken soup and expects me to be constantly checking on him to see if he needs another cold drink or whatever. When I'm really sick, I just want to go to bed and be left alone. If I want a drink or something to eat, I still get up and get it myself!

[Bobbie]

Sarah,
My DIL has fibro and has days of awful pain. She's on a couple of meds. The party sounds like such fun; I hope you can enjoy it.

seekingcure,
I read something about your mom's house being broken into while you were gone. I have to reread - hope you had a good time in Raleigh. and enjoyed those grand kids.

Afraid we are all in the same boat, ladies. My favorite saying is, "Let them give birth."

Thanks for the support. Much appreciated. Welcome, abnova.

[AllisS]

saraht wrote:
I don't understand these insurance companies.

I believe I DO understand them, and my understanding is that they are criminals. Not just figuratively; actually. Of the lock-them-up-and-throw-away-the-key variety.

Hope you feel better and that your little girl has a fun birthday.

Allison

[ncmimi4]

Bobbie, I am so sorry for you in all this. You have been so kind and helpful to me and so many others it seems wrong that you should have such problems. Is there some foundation or help out there that would subsidize the cost for you so you don't have to go through the insurance? Have you contacted the drug company that makes it? The makers of Dificid were the ones who told me about the foundation that helped me. Sending good thoughts your way.

[seekingcure]

I just ran across an interesting article about why prescription drug prices are so high in the US. Pharmaceutical companies spend over $250 million a year on lobbying to keep it that way. I also had seen a video about the Medicare Part D provision being passed through Congress in the middle of the night to avoid too much media coverage. Reportedly the bill was drafted by pharmaceutical companies who wanted to be sure that a provision that would keep Medicare from negotiating for lower drug prices would be included in the bill. I'll try to post the link to that video too.

http://www.nytimes.com/2013/10/13/us/th ... reath.html

http://www.upworthy.com/the-video-you-n ... are?c=ufb2