(See previous post for the whole story.)

My doctor’s office finally called me back last Monday, and made a telephone appointment for me with the doctor for three days later (on the 17th). I have to say that my opinion was not materially changed by this interaction; in fact, I felt like she was gaslighting me a bit for most of it.

She insisted that she filled out all the codes that Medicare requires and sent all the relevant paperwork, without ever either confirming or denying that that included the sleep apnea tests. I told her about the endless phone calls I had made to her office and about how her staff promised each time to call me back the next day but never did, and she said she was only aware of three phone messages from me. I said “And you didn’t think that was sufficient to tell someone to call me back?” and she did apologize for that, but then went on and on about her busy practice and how she has 80 file folders stacked up in her box and if something is laid on her desk and then something else goes on top of that, she will only find it when she gets that far down in the pile. She said she would tell her people that my phone calls were top priority; I replied that all patients are top priority—especially if they call you six times. She said it “seemed like” she needed to have a conversation with her staff, at which point I realized that she wasn’t taking this seriously, and that if she DOES have that convo, I will be the villain who brought the wrath of the doctor down on their heads and will never get past that with them again—a sufficient reason to leave, I think.

She offered to follow up and try to make good on the prior authorization, but at that point I thought about the old “fool me once” saying and said no, thank you.

So…I called a specialist I had seen at UCLA once and asked her if she would be willing to take on the appeal. She referred me to a colleague who is both a doctor and a nutritionist and who specializes somewhat (she has a team for this!) in writing prior authorizations. I booked a telehealth appointment with her for this past Tuesday afternoon (the 23rd) and explained the entire mess to her; she asked me a bunch of health-related questions, reviewed all my materials, and said she would put her team on it right away. One of them would call Optum Rx to see how they would like to proceed, and then would put the whole thing together, and that if I didn’t hear from her by next Tuesday, I was to call her. She warned me that it could take anywhere from a week up to 60 days to get the Zepbound, depending on whether they treated this as a fresh prescription, a continuation of the prior authorization my GP had written, or a brand-new prior authorization, so I sighed and settled in to wait.

Last night at 5:30 p.m. I got a call from Optum RX saying that my prior authorization had been completed and I had been approved for Zepbound and could call my pharmacy to fill the prescription. It took her 48 hours from start to finish! I am so, so grateful for consideration and competence! She didn’t have to sit down that same afternoon and write up her notes; she didn’t have to put her team on it that afternoon; but she did, and everyone did their job properly, and it worked. I’m practically in tears. (She also told me to take tart cherry for my joint pain.)

Walgreens is, of course, “out of stock” on the drug; I’m looking into another source. (Not every happy ending is perfectly realized!) But by early next week I will get the chance to see if this is an answer to my inflammation and swelling problems, not to mention the sleep apnea and weight loss for which it is intended.