United Healthcare decided that there were new guidelines for one my husband's medications.Unfortunately,they informed no one. So as requested by the Specialty Pharmacy, I contactedBrenda for Pre-Authorization for this medication.
My husband has been on this medication for 6 years. Never a problem. In the beginning, Brenda set us up forCo-Pay Assistance, without our even asking if such a thing existed. This was huge and we were grateful. Things went along smoothly with the insurance for all these years until this year.
Brenda submitted the Pre-Authorization documents. She contacted me regularly to keep me informed. It was denied. By this time my husband was out of medication. We couldn't afford it at full price from a pharmacy. Neither she nor I could get a straight answer from the insurance company as to what the problem was and how to rectify it. She stuck with it, constantly resubmitting, calling, asking questions, and not giving up. When she hit a wall with the insurance company, I would make calls.
She submitted and was again denied. Then she filed an appeal, calling and asking what is their issue. Never getting a clear answer, the appeal was denied.Remember he's been on this medication, necessary to his quality of life for 6 years with no problem. Now 2 pre-authorizations and 1 appeal all denied him. That's enough to make anyone throw in the towel. I know because I was fighting for this too. It wasn't easy but I had anallyin this battle. We continued for over 7 weeks.For Brenda who has patients and other responsibilities, I'm sure this added a lot of extra work and time to her day. She always took or returned my calls. She'd listen to my newest idea to make this happen. She'd share her ideas. I knew I could count on her. It seemed as though we were out in the cold and the insurance company had lost its mind. She was strong for me on days that I was so frustrated with this process.
She never talked of giving up andfinally,we succeeded. I believe that is due to the constant questioning and pressure that was put to them by Brenda advocating for my husband. We won! Unbelievable! We were relieved and grateful.
My husband has many health issues and just as many doctors. Never have I had such care,support,and determination from any medical professional. Brenda is sweet, kind, and has a positive attitude and a beautiful spirit that can keep you hopeful when you can't see how things could work out.
Brenda deserves The DAISY Award just for the battles she fights for her patients. She is an amazing person to whom my husband and I will always be grateful.