OMG! What a nightmare.

[KristyW]

Ok folks...time for me to vent...and it's really not "life threatening". I'm going in for a hysterectomy next Wednesday (the 28th). My PCP (not the one doing the surgery...that's my OB/GYN) is very good and said..."Stop taking your warfarin 5 days prior and start Lovenox right away...that way you're sure you're covered." So, I'm to take my last dose on Thursday...and I'll start the Lovenox either on Friday night or Saturday am. I think that either would be ok (I've been running a bit high anyway).

Doc gave me the Rx last month, but I waited to get it filled until Monday (5 days lead time). Not knowing if it needs refrigeration or what. Here's where the frustrating part comes in...apparently, the Rx was for a dosage that they don't make. The pharmacist called my Drs. office and left a message for clarification (with the wrong Dr in the practice). I went in yesterday (Wednesday) to pick it up, and she told me about the dosage problems and the no call return from my doc. I called my doc and spoke with his PA. She talked with the Doc and called in the right dosage in 10 minutes. No problem...right? I can still pick it up Thursday night and have it for Friday/Saturday. Well...no! The pharmacist puts in the script to her computer to tell me what my co-pay will be, and it's kicked back! (Needs authorization). So now, my Dr. (not the one doing the surgery) needs to send why he's prescribing this so the (prescription) insurance company can decide whether or not they'll pay for it!

If they won't approve it, I'm on the hook for a $900 prescription that's necessary, but I can't pay for! Hopefully I'm just stressing about nothing.

Of course I could have avoided all the time sensitive stress if I'd just have filled the Rx when I got it...but I didn't have the co-pay for it then...

Thanks for letting me vent.

Love you guys!

 

[Lisa in Katy]

Hopefully it will all work out. Prescription services usually approve Lovenox as it is cheaper than the alternative - hospitalizing for Heparin drip. I went through something similar when I had my hysterectomy as I also waited until the last minute (partly by choice, partly because that was the first time I went off Warfarin and didn't know any better) and found that many pharms don't stock Lovenox, but order as needed with a 2-3 days turnaround time. I had to go to 4 different pharms (Safeway, Walgreen's, CVC, different Walgreen's) before I found one that had it in stock.

 

[bvdr]

I hope it is getting straightened out for you. I think the process of coming off and getting back on warfarin for procedures or surgeries is what I have found requires the most patience with ACT. It is of course doable and necessary but it often causes me to sigh when I have to do it again.

I wish you well with your Hysterectomy. Be patient with yourself during recovery. Sometimes it zaps you a little more than you expect. If you have an abdominal incision be prepared for a lot of numbness in that area for months to come. It is totally normal but sometimes they forget to tell you ahead of time.

 

[COLLEEN S]

This is why we need health care reform, and a public option.

 

[KristyW]

Update...my insurance company denied the lovenox. Now I have to have heparin injections...not sure how that works...the PA says it's the same schedule...1 injection every 12 hours.

Sheesh!

 

[KristyW]

No Lisa...I specifically asked..."Do I need to be admitted early then for a drip?" The answer was no...these are 2x/day injections. I guess we'll see.

 

[ALCapshaw2]

It sounds like you need to have your PCP contact your Insurance Company (preferably have Doctor to Doctor conference) and explain why it is absolutely necesary to Bridge your for this procedure.

Did the insurance company approve Heparin?
or do they just want you to do without any bridging?
WHO issued the rejection? Does that person have any Medical Background? Did you file an Appeal?

If worse comes to worst, you could reschedule your procedure until your Doctor and your Insurance Company can come to an agreement on how to treat you. I'm sure your PCP just loves having the Insurance Co. tell him how to manage his patient!

'Al Capshaw'

 

[Blanche]

You might want to check with a doctor who is used to administering heparin.

I agree with Lisa. Albert has had to have Heparin at least four times in the last 10 years. Each time he was hospitalized and they tested him several times a day. Heparin has a very short half-life, which means it leaves the body quickly. I honestly do not think that a shot of heparin every 12 hours is an approved way of administering the drug. I think the blood test they took frequently was a ppt, or a pttp???? It isn't the PTP test that we all take regularily.

The last time Al was in hospital, two years ago, a hospitalist doctor said he really wished that Al could hold on and not take any "blood thinners" for a while....to clear out his system!!!!! I told him that I thought he was out to #%&*ing kill Albert. Albert requested a different doctor annd I asked for a clinical second opinion from heart surgeon from the The Arizona Heart Institute and Hospital.

I am so sorry that you have to deal with such problems at this time.

May I suggest that you contact Al Lodwick. I'm sure he would have some good advice for you.

Blanche

 

[kfay]

I'm not an expert on this stuff, but I know both times this year I had my ablations, I was on a heparin drip in the hospital and sent home on Lovenox. I had a reaction to the heparin while I was in the hospital and they stopped it immediately and told me not to worry, it would be out of my system with in a couple of hours. Within an hour and a half, I felt completely normal. I think you definitely need to make sure you know what you are getting here and that it is going to cover you. I agree with Al, I might postpone this until I could get it all worked out.

 

[KristyW]

It sounds like you need to have your PCP contact your Insurance Company (preferably have Doctor to Doctor conference) and explain why it is absolutely necesary to Bridge your for this procedure.

Did the insurance company approve Heparin?
or do they just want you to do without any bridging?
WHO issued the rejection? Does that person have any Medical Background? Did you file an Appeal?

If worse comes to worst, you could reschedule your procedure until your Doctor and your Insurance Company can come to an agreement on how to treat you. I'm sure your PCP just loves having the Insurance Co. tell him how to manage his patient!

'Al Capshaw'

Al...I can't wait any longer for this surgery...it's making my life miserable the way it is. The bridging was approved...but the Lovenox wasn't. This is where things get complicated...you have to remember that pharmaceutical insurance is not the same thing as medical insurance. The Rx insurance declined to pay for Lovenox, but they will pay for injectable heparin. Lovenox for 5 days is $900. Heparin...a fraction of that. they didn't say I couldn't HAVE Lovenox...just that they won't PAY for it.

I'm contacting the pharmacy now. I want to talk with her first (after all, she knows about drugs). Then I'll talk with my PCP.

 

[KristyW]

Update #2. Ok...spoke with pharmacist, there is an injectible heparin...once or twice a day (depending). So, it looks like my PCP knows what he's doing, but I've had to jump through a lot of hoops to get this done. If there's a next time, I won't wait until the week before. I'll get it done a month before!!!

 

[njean]

Whew! Glad the issue was resolved for you!! You certainly don't need all this stress right before your hysterectomy!!!

Wishing you the best BTW!! (I've been there, done that too --- you'll be fine --- the best part is not having a . anymore!!!!

 

[KristyW]

Whew! Glad the issue was resolved for you!! You certainly don't need all this stress right before your hysterectomy!!!

Wishing you the best BTW!! (I've been there, done that too --- you'll be fine --- the best part is not having a . anymore!!!!

Thanks Norma...there's been more thrown in later today, but I'm confident that we'll get it worked out. It all has to do with pre-authorization through the prescription drug coverage. Not outright denial, but it must be preauthorized.

Oh well...I'm not going to worry about this anymore today.

 

[ALCapshaw2]

Kristy -

What is the plan for After your procedure?

This is where the Surgeon and Cardio / anticoagulation manager debate the risk of bleeding vs. risk of stroke.

Have you discussed when to resume the Heparin Shots?

After reading some of the stories where bleeding was an issue, I'd recommend discussing a 24 to 48 hour hold on the Heparin. Coumadin is so slow acting that you could probably start it 8 hours after the procedure. But again,
I would recommend getting an agreement between your Surgeon and Cardio or AC manager.

Hope all goes well for you.

'AL C'

 

[KristyW]

Kristy -

What is the plan for After your procedure?

This is where the Surgeon and Cardio / anticoagulation manager debate the risk of bleeding vs. risk of stroke.

Have you discussed when to resume the Heparin Shots?

After reading some of the stories where bleeding was an issue, I'd recommend discussing a 24 to 48 hour hold on the Heparin. Coumadin is so slow acting that you could probably start it 8 hours after the procedure. But again,
I would recommend getting an agreement between your Surgeon and Cardio or AC manager.

Hope all goes well for you.

'AL C'

Al,

I'm going to be in the hospital a minimum of 3 days. My OB/GYN surgeon is deferring completely to my PCP on anti-coag matters, and he seems to be pretty on the ball. My PCP's office is attached to the hospital and he will be following me while I'm there. I've had absolutely no complaints about the way my PCP manages me. A couple weeks ago I tested 5.1 (after a 5.0 the month before) and he wanted me to hold for 2 days. I asked to take 1/2 dose for 4 days instead (same reduction, but no skipping) because I didn't want to be without coverage totally. He agreed and 5 days later I was at 2.4. Like I said...I have no issues with him.

I'm confident with my Drs...just not my insurance companies.