Insurance Companies Just Aren't Fair

Right now I am not very happy with our medical insurance company. We have never had a problem as far as insurance goes until this last year. I have never had to worry about taking my kids to the doctor or going myself. I always knew what the co-pay was and it was very affordable. We've always had the same co-pay on prescriptions and they also have always been very affordable. I've never had a reason to complain, until now!

I've been seeing my current doctor for the last three years. We moved here three years ago and he was the doctor I chose as my primary care physician and I've stuck with him. He's seen me numerous times and has also been the one to prescribe my medications. Now, there has been a time or two where I've gone to urgent care when I was really sick and needed to be seen right away. But 99% of the time I've got to my regular doctor. Last year I had some medical issues and I was put through a bit of testing. Nothing ever came of it, but I was very happy that my doctor had taken the time to have the tests done just so I knew nothing major was wrong. I was quite pleased with how easily everything had worked out. I had to have an MRI and an MRA done and the cost was great for what the tests cost so no complaints there.

In October I saw him due to a small issue I was having with my heart and I was supposed to come back six months later to check in. We decided that I would stay on the medication I was currently taking and he was going to add another one to see if it would help. He gave me two scripts the day I was in his office. One was for a seven day trial. There was supposed to be a coupon I could print out to get this trial for free. The other was for the full 30 days. I couldn't figure out why he was so adamant about doing the seven days free. I was supposed to be leaving for Indiana that evening so I sent my husband to the pharmacy to fulfill the 30 day script since I was about to leave. He calls me back and says that it was going to cost $323 to have it filled. Of course I told him not to do it. Apparently insurance needed some sort of paper saying that this medicine is indeed needed. Here I am thinking to myself that if I didn't it, it never would have been prescribed. So I call the doctor's office and speak with his nurse and she tells me that he's sending the paper off. So about a week later I find out that they have denied it. My doctor then did an appeal to try and get them to pay for the medication. They came back and said no. They didn't feel that I really needed the medication. Here is my question: How would the insurance company know what I need? Have they ever met me? Do they know what any of my issues are? Do they know why my doctor feels that I need this medication?

As you can probably tell from reading this I was very upset. My first thought was how do they know what I need. More importantly than that is the fact that we pay hundreds of dollars a year for insurance and for what? I thought it was so that when we needed it we could use it. I mean isn't that why we pay for it? Apparently I'm missing something here. It's been a few months and I'm still not over the fact that they denied me having this medication. I think that I could feel a lot better by taking it. I also feel that it is unfair of them to decide what I might need or not need based on a chart!