Approved

The medical office for Dr. Wonderful called yesterday and delivered the great news that they had prevailed over the insurance company. I was surprised it had gone through so quickly and easily, and Dr. Wonderful's medical front office person chuckled and said she had found a lovely loophole. The medication was approved not because our doctor thought it was the best medication for Nolan, but because of some quick thinking on the part of our doctor's medical office personnel.

The story, as related to me, went something like this:

I dropped off the prescription, and our pharmacist called to get insurance approval. The insurance denied the claim, and forwarded the information to Dr. Wonderful's office. Dr. Wonderful's office then sent the information back that the medication was urgent and the child in question needed approval quickly due to the severity of the case. Again, a big red DENIAL. So Dr. Wonderful's office decided to save the big battle for Wednesday, when there would be no one around. Just in case things started to get a little "loud."

She called and restated the information, that this child needed this medication. And he needed it quickly. The insurance company's response?

"Absolutely not."

She lobbied again and again, to no avail. They insisted Nolan take the cheaper drug, even though it was not recommended by our doctor. They would not approve Nolan to take Nexium until he had tried Prilosec and it had failed to work.

Then Dr. Wonderful's office noticed something. The Prilosec the insurance was willing to pay for was not only less effective for our little guy, it was also a PILL. Giddy with her plan, the office called the insurance person back.

"The medication you will approve for this child is a pill. He can't take a pill."

"He can take a pill. We are approving the pill."

"He's two. He can't swallow a pill."

"Why can't he swallow a pill?"

"He's TWO. YEARS. OLD."

"And how does that make him unable to swallow a pill?"

"It's a choking hazard!"

Silence.

More silence.

"The Nexium is approved."

So, on the basis that Nolan might choke to death on the cheaper drug and therefore cost the insurance company even more money than the cost of the Nexium, we have approval.

The kicker is the phone call I received about 10 minutes after I hung up with Dr. Wonderful's office.

*ring*

"Hello?"

"This is XXX Insurance Company, and I'm happy to let you know your son's medication has been approved without delay!"

Yeah, right, buster! I know the whole story. And I also notice that you never call when you're denying things, only when you have finally succumbed to approving something after a fight.

At least we have Nolan's medication approved for the next year, no matter what hassles we have to go through to get it!