05/16/2025
Gotta love insurance…
On April 24, Roman had an appt with the CP clinic (cerebral palsy). Our doc ordered many things including a new rx for his seizure rescue med. He has not needed it since he was about 2 years old and what we had on hand was expired.
He has mild focal seizures here and there but has not had a tonic clonic (grand mal) in over a decade.
On May 5, Roman had a cluster of 6 tonic clonic seizures.
I treated him with a high dose cannabis patch and watched him all night.
I immediately notified the doctors office of this event- And followed up on the rescue med order that still had not been filled.
We agreed it should be a nasal med vs the re**al one we had when he was little.
Daily I’m checking the pharmacy app to see if it’s ready and calling the pharmacy to find out why it is pending so long.
They explained a prior authorization is needed by insurance.
So immediately I notify the doctors office this is needed.
I get a reply the next day saying this:
Hello,
We have received the request this morning around 7:44. Please follow up with pharmacy for further details. Any questions please feel free to call our office at 314.454.6120 option 6.
Thank you
Pediatric Neurology
I thought, well that’s vague- is it done or not? Ultimately that office is pretty good so I gave the benefit of the doubt that it was handled.
I rush out today to get his meds before the severe storms hit only to find out it still has not been filled.
Wtf?!
Pharmacy explains that Aetna denied the prior authorization for the rescue med, VALTOCO® (diazepam nasal spray) and since Aetna denied it; Home State Health denied it also.
Well you tell me, how good is a rescue med if YOU DONT HAVE IT?!
Only option at this point was to go back to the doc office and start the whole process over and try to find a med the insurance company thinks is worth paying for; OR just pay for it.
How much is it? $2195!
$1904 after they found a coupon.
So here we are with our $1904 rescue med but at least now we’ll have it and someone else is a bit richer for it.
Absolutely ridiculous.
So if you’ve noticed that we’ve been quiet on here- that’s why. We have been swamped with appts- both Roman’s specialists, tests and therapies and my OB and constant communications with insurances, pharmacy, doctors offices.
Not to mention round the clock monitoring him.
Especially since his EEG last week showed he had a 7second tonic clonic that I didn’t even notice, while sitting right next to him. I have been hyper vigilant.
I’m typically pretty easy going, but everyone has seen my frustration today. This is not acceptable.
We pay for TWO insurances! Yet they can’t provide potentially life saving medications when needed.
