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  #2596  
Old 02-10-19, 10:49 AM
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Re: The what's bothering you RIGHT NOW thread Part V

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Originally Posted by sarahsweets View Post
The only reason I won my appeal was because I went into my husband's human resources department and laid it all out for them. It started in July when the three a day I was on was no longer covered anymore. I had been trying to get 4 covered because I was on three a day of xr and 1 of ir and wanted all xr-plus I had a vacation override so I think internally I triggered some kind of review. Its funny that these companies act like their review and appeal process is even helpful or possible. Of course they dont want to pay so they say no. I started with the patient advocacy that his employer offers to advocate on the behalf of the patient. 2 months of calls, lost paperwork, poor communication in the insurance depart. The advocate gets on the phone and is the nasty one. So after all that I was left with my doctor needing to have
"peer reviewed cited scientific evidence " for a final appeal. That is when I snapped. Went into HR and laid it out with records of all I had done thus far. Told them my theory based on the fact that it was a controlled substance and asked them why an insurance company is allowed to make medical decisions in place of my doctor when previously they must have had evidence that I did indeed need at least three a day and all of a sudden they determined I did not. All this time I was told I had to pay for it in order to demonstrate a justifiable need- meaning if I need it this bad I would even pay for it. I saved all my receipts. I was assigned an individual from the insurance company that actually had a phone number I could call but I stayed up HR's butt about it. All of a sudden last week I found out it would be covered and they called the pharmacy and were able to re-process about 6 claims. I need to go back into my receipts and find out if there are any unleft that I could get processed. Again- since July this has been a thing. I encourage anyone who has a halfway decent HR department to try their luck with them should you fail because over all they respond to you directly and are more affected by your personal story and evidence.
It’s nice to see someone take on “the man” and win. Way to stick with it.
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  #2597  
Old 02-10-19, 11:28 AM
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Re: The what's bothering you RIGHT NOW thread Part V

I've been listening to some of the Beatles songs this weekend and in Eleanor Rigby there's one like that really stands out:

"wearing the face that she keeps in a jar by the door"

That's exactly how it feels I live day to day outside of the house, inside the house I'm different to the brave face I put on outside of the house. Tigger and Willow comfort me when I'm indoors <3
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  #2598  
Old 02-10-19, 12:16 PM
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Re: The what's bothering you RIGHT NOW thread Part V

It's a rainwater /stormwater runoff said they would tax everyone at 163.. funny how the laws don't apply to the corporate magnums just us plebians..once again this ain't about common sense but money..all they have to do is ban fertilizer and stop building frivolous mansions on the bay n.ocean. fertilizer is what is killing barnegat bay but our politicians can't seem to get out of bed w big pharma and the petrol chemical industries..
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  #2599  
Old 02-10-19, 12:19 PM
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Re: The what's bothering you RIGHT NOW thread Part V

Friendly reminder: Political discussion is currently prohibited outside of the Debates section.
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  #2600  
Old 02-10-19, 12:31 PM
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Re: The what's bothering you RIGHT NOW thread Part V

I am "bothered" to put in mildly, that my married ex-boyfriend from high school hasn't messaged me back. He messaged my sister on FB while drinking first with he still loves me, I'm what he compares all other women to, blah, blah, blah. (I'm not his FB friend. I declined when I first joined years ago as I don't think it's wise. He's re-married w/ kids.) The next day messages her back and got into his mental health situation over the last 6ish years- his depression, not being suicidal anymore, had been hospitalized in the past, he did a lot of damage to his marriage, meds are working, sees either a psychologist or psychiatrist once a month (he said "my psych doctor"), his PCP every 6 months and he's doing better BUT when asked by her what prompted the drinking last night he said this:

"Anger, a very large self-destructive streak (I was prepping to do harm to myself), and general stupidity."

WTH??? He might be better but not good at all! The meds aren't fully working, maybe they are to a point but it's not good enough!! Did he get drunk to do the harm OR to forget that he wanted to do the harm??? Was he talking about self-injurious behavior like cutting or a suicide attempt?? He wrote to my sister all in the past-tense about his struggles then writes about why he got drunk- the night before!!

I see this at work frequently but never in my own life with people I care about. I really struggled with what to do as I do not want to give him false impressions or have his wife think anything other than wanting to help, but the psychiatric RN in me won so I messaged him that I want to be of assistance and what I do for a living now. I could not live with myself if I hadn't reached out and then something happened.

I wrote this message at 10:30 pm Friday: Hi~ My sister shared that you two messaged over Facebook. I am extremely concerned about you. I want to communicate with you as I hope to be of some assistance as I am a psychiatric nurse on an acute inpatient unit. If you are amenable to communicating, you can choose which way is most comfortable.

His reply at 2:04 am Saturday: Is your favorite animal still a swan?

My reply at 7:15 am Saturday: Did you actually read what I wrote to you? I would like to communicate with you because I hope to be of some assistance with what is going on. I have experience with people in situations like these in the work I do as a psychiatric nurse. As I said before, I am extremely concerned. I don't want to be rude and ignore your response to the first message- no, it is not and never was. Please seriously consider the offer and message back.

I was dumbfounded, shocked, mad, confused and even a little hurt at his response. I would've been much more ok with "MYOB, leave me the f*** a lone." I know where to file that but I don't know where to file that one. And it's not even at all correct! My response was maybe...terse?

What I want to share are meds that decrease self-injurious behavior and suicidality. I see all of this literature at work on treatments like off-label uses, what the FDA recently approved, clinical trials, non-pharmaceutical treatment, etc.

If he doesn't message me back I'm typing it all up and attaching in Messenger. I can do that, right? If not, he gave his cell # to my sister, which I have now, and I will CamScan the pages and text it to him- or maybe have my sister do it as he doesn't need my cell # or does he??? We want our patients to reach out to anyone they deem helpful when they are in crisis and having more options, the better. We give about 6 crisis numbers on our discharge paperwork. Idk....I'm a basket case right now.
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  #2601  
Old 02-10-19, 03:57 PM
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Re: The what's bothering you RIGHT NOW thread Part V

I didn't even know there was such a thing as meds that can help those from wanting to self harm till just a few weeks ago (it got brought up in a group I'm part of).

...I'm no good when it comes to relationships...so keep that in mind.

But something about this whole thing feels off to me. It sounds like this guy may well just be seeking attention. Or like he's using your sister to vent to...and when venting, it can be easy to over blow things sometimes and make things out to be worse then they really are so that the person/people you're venting to feel really sorry for you (cause let's admit it...it feels really good sometimes when people feel bad for us and our situations).

I don't know the guy or your history with him...but I don't like the idea of you becoming overly involved with him, if all he's going to do is play games.
You don't deserve it and it'll only eat at you and will likely leave you bitter and angry.

You can't change this guy no matter how badly you try or want to .

You're a very good person. Sometimes it can hurt to care so much.

I just hope you can use caution going into this with him.

I hope I haven't upset you. Maybe I shouldn't even reply...I really am not so good at relationships, so I don't have much experience with these kinds of things.

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Old 02-10-19, 04:33 PM
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Re: The what's bothering you RIGHT NOW thread Part V

Quote:
Originally Posted by sarahsweets View Post
I was left with my doctor needing to have
"peer reviewed cited scientific evidence " for a final appeal.

Told them my theory based on the fact that it was a controlled substance and asked them why an insurance company is allowed to make medical decisions in place of my doctor when previously they must have had evidence that I did indeed need at least three a day and all of a sudden they determined I did not.

All this time I was told I had to pay for it in order to demonstrate a justifiable need- meaning if I need it this bad I would even pay for it.
And you'd think they'd pay attention to the requested bit of evidence, but that's not always the case. I haven't thought of the "tell them your theory" idea, but I might try it. That last bit is so irritating. We pay for insurance and expect them to do the job of covering what they say they'll cover. It certainly shouldn't be a matter of "if you need it that bad you'll pay for it". Kind of like the "if you can buy cigarettes you can buy your meds" argument. Very condescending, not to mention purposefully missing the point of the argument.
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Old 02-10-19, 08:26 PM
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Re: The what's bothering you RIGHT NOW thread Part V

At this point I.think i rather buy smoke Em's n I don't even smoke
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Old 02-11-19, 01:15 PM
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Re: The what's bothering you RIGHT NOW thread Part V

Just got back from lessons , listenning to music
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Old 02-11-19, 04:21 PM
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Re: The what's bothering you RIGHT NOW thread Part V

Bothered by the fact that in 2 days mom will be gone 18 years.where did the time slip away too?
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Old 02-11-19, 05:02 PM
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Re: The what's bothering you RIGHT NOW thread Part V

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Bothered by the fact that in 2 days mom will be gone 18 years.where did the time slip away too?


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Old 02-11-19, 05:03 PM
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Re: The what's bothering you RIGHT NOW thread Part V

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Bothered by the fact that in 2 days mom will be gone 18 years.
Sorry for your loss. it's been just over 5 years for me.

i was thinking of this funny memory earlier today:
that song "Delilah" came on the radio when we were in the car, and she got really annoyed that I liked it because it "didn't have a good rock beat, like Nickelback"
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  #2608  
Old 02-11-19, 05:16 PM
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Re: The what's bothering you RIGHT NOW thread Part V

s Rebs
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Old 02-11-19, 05:26 PM
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Re: The what's bothering you RIGHT NOW thread Part V

I miss you mom
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Old 02-11-19, 08:27 PM
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Re: The what's bothering you RIGHT NOW thread Part V

My mom has been gone 20 years.
My hubby has been gone 16 years.
My sister has been gone 12 years.
My son-in-law has been gone 3 years.

Sometimes it seems like just yesterday that I saw them.
Sometimes it feels like forever.
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