insurance verse orexin...
So, I did my required trial of amodifinal. I feel like Im on a constant caffeine over dose - my nerves are over aggitated and buzzing, my focus is unfocused, i spent weeks trying to not clench my jaws (i have no teeth to grind from affects of the sjogrens) and give myself worse head aches...
I feel like Im having the physical symptoms of an anxiety attack all day every day.
AND still suffering from sleep attacks. Even when I'm not actively fighting to stay awake, my brain is still fuzzy and when I am fighting, it's worse than it ever was.
Even maxed out. Even splitting the doses so they don't all wear off at one time. I no longer need a nap some days - I now need one every day. For the first time in my school career, I've missed deadlines. I can't think, I definitely can't read...
My diagnosis is new but I've lived with this condition my entire life and I have never fought this hard just to get by.
I can't take anything that will make me sleep, because Im a single mom with young kids, and since the meds my sitting up, cant focus long enough to even lay down, talking in my sleep, continuing to function has gotten so much worse. I have fallen over and broken a tv before sleeping standing next to my bed so generally my space is set up to be fairly safe... but i fell asleep going 5 mph on the treadmill yesterday...
Anyway - my doctor switched me to sunosi. Somehow, the prior auth got denied. I really think it was whoever sent it in not knowing their job - when i asked why my med was still delayed after 10 days, i got a message saying the p.a. was denied and a pa was working on an appeal... a week later i got a letter from the insurance about the denial, which said it was because I hadn't "failed modafinil" but that the original prior auth should have addressed that the formulary considers armodafinil the same medication for meeting the requirements purpose... so i wrote to the dr again asking how the appeal was coming and a different pa basically ignored my statement and explained that they aren't the same meds because armodafinil is stronger and longer lasting, but if i really wanted the sunosi, maybe i could get a coupon... (its not even that she's wrong, it's that she seemed to miss the point that I already failed on the better med, and this isnt about "wanting" - but also, ma patients are not allowed to self-pay, let alone with coupons... ) but "someone was working on my appeal" and then when i wrote back nicely explaining that i am aware the difference, along with how the insurance formulary is written, and I was going to file my own request for an expedited appeal if there had been no progress, pa #3 wrote back to say the appeal process was being started.
I went ahead at this point and submitted my own appeal, because this is what I do and it was getting to be untenable living without it. It SHOULD have been a 3 day turn around time - I specified an expeditied appeal or a peer-to-peer review, whichever was faster...
i got a letter this morning saying the doctor's office has filed a grievance on my behalf and when I return the agreement, a panal will be convened and I'll be given 10 day notice to get together my proof and prepare my case...
ALL I NEEDED WAS AN APPEAL THAT SAID "SHE FAILED THIS MED"
and because the grievance process was started before my appeal - and they are not the same thing - its going to take forever.
i have another option - i can contact the state and tell them my insurance violated my right to an expedited appeal. but that's the nuclear option.
at the same time, i can't continue this way - all my other autoimmune stuff has been activated, my grades and my job are suffering, my quality of life is meh and im always irritated and in pain...
i try to be the most optimistic, cheerful, something good can be made from anything type of person... but this just stinks.