Part Two: The Testimony

If you haven't read about Naomi's arthritis journey so far, you can pop back a post and read about how we came to be in this juvenile arthritis world. I wrote it to lay some groundwork for this post. The work that goes into getting a med change approved through insurance, supplemental insurance, pharmacy -- all coordinated through the hospital.  Once this massive machine is up and running, though, you forget all of the work and things run like clockwork. Until there is a change.

In July of this year, we got a letter in the mail that Jerry's prescription insurance is changing carriers effective August 1. It said in the letter that this would hardly affect us, we would probably not even notice the change in carrier. Except I knew. I've had to explain the medical history so many times, I didn't think for a minute that this wouldn't affect us. So obviously I sat on my bed and cried. It's often one of my first steps in dealing. 

We made it through the change rather unscathed. I mean, I spent hours talking to new insurance carrier, and they of course didn't have actual information until August 1 when the coverage started. And I talked to their normal department. They told me I would have to get Naomi's medication through the mail order because they considered it a maintenance medication. (Yes. They told me Humira for a ten year old was considered a maintenance medication. No. I didn't scream.) I talked to their mail order department, who although have heard of Humira, weren't sure that it would have to be a mail order prescription. They then sent me on to the specialty department. Each time, I get to explain the medication, the history. And generally, I get transferred to a different department.

Shortly after the transition in August, I got another letter that they would only cover it in 90-day supply. I asked if that was accurate. It is a concern for us, because the arthritis insurance is a branch of medicaid and they ONLY cover 30 day supplies. One representative told me it didn't matter, this was her primary insurance and what they say is how it will go. I let her know that I was uncomfortable housing $10,000 worth of Humira in my fridge. What if we lost power? (We have a generator, so that was more rhetorical.) What if my fridge breaks? Humira has to remain refrigerated until 30 minutes before the shot. But back to the biggest factor - I AM UNCOMFORTABLE HOUSING $10,000 WORTH OF MEDICATION IN MY FRIDGE.

That got worked out. A nice man let me know that no, it is not a maintenance drug (right?!!??!), and that they will continue covering it as a 30-day refill. 

Then last week, we get another letter.

Our coverage is changing, and they would like us to change our medication from Humira to..... "contact your physician."

First step, I called the insurance company. The lady I spoke to was very nice. She ran a practice claim through to see what this would mean for us. There was no information. All she could see was that it would require a prior authorization on January 1. There was no way to see what it was in regards to, we would have to wait until January 1.

So I called the hospital and I called her arthritis insurance. Because if you ever want to understand what's going on in the insurance world, the ladies that deal with it daily are a glorious wealth of information.

From this letter, it would seem that maybe they are just going to increase the copay? That's one guess. I asked if it would affect her if that was all it was. The U of M nurse said that her arthritis insurance only covers what her primary also covers. If our insurance decides she can't have Humira, then that's it. She doesn't get Humira. The only other option for her at this point is a drug that is by infusion. An IV med that requires a half day appointment at U of M. Neither of us understood why they would think that was better.  I asked her what I could do (she's the insurance ninja). She said you become an advocate. Call your representatives. Call your senator. Call anyone you can. And ask for insurance reform.  Write letters, make phone calls, contact offices.

Except I'm tired. And I don't really know a lot about all of the politics that go into insurance. If I absolutely had to, I'm sure that is exactly what I would do. But that is not what I wanted to do. 

Then yesterday.  I was cleaning my house, because that makes me very happy. I was sweeping my kitchen and praying. I let God know that I did not want to be an insurance advocate. I didn't want this to be how I spend my time. I know it's important, but please, not me Lord. Please don't let this be Your will for me. I know I'm being called to something, but please don't let it be insurance reform activist. 

Then my mailman came and beeped his horn. When we have a delivery, he drives up the driveway and beeps and drops off the package and the mail. So I stopped sweeping and grabbed our mail.

On top was a letter. From the prescription insurance carrier. 

And I set it on the counter.

I couldn't bring myself to open it. I was praying for an answer, and I wanted to make sure that God heard my actual prayer? Maybe I wasn't clear....  The last thing I wanted to do was read what these jerk faces had to say (as a general term regarding the insurance carrier - their employees have been quite pleasant).

So I prayed more, and I mopped.  Please don't let this be Your will for me. I don't have the energy to learn how to do this. Use me in a different way.

After I finished mopping, I opened the letter. I had to know what else they were going to throw at me. I was ready.

I stood in my kitchen and openly wept. My face in my hands, weeping. Please disregard the previous letter because your plan will continue to cover this medication. We apologize for any inconvenience this may have caused. 

I was literally praying to God to stop this, don't let this be our path. And I was handed a letter during my prayers with the exact answer. The timing took my breath away. The greatness made me cry, a lot. 

I don't even know if maybe down the road, insurance advocate will be my role. I'll do what is needed, when needed. But thank you, Jesus, the answer is "not now."  

I knew I had to share this. The timing of the answer was perfect. God's perfect timing. Lord, hear our prayers.