I'll spare you the detailed dialogue generated by the fifty-five minutes I spent on the phone with a pharmacy clerk #1, pharmacy supervisor #1, insurance claim processor #1, insurance claim processor #2, insurance supervisor #1, and pharmacy clerk #2, and just give you the rundown on the key statements and events. Modern health care at it's finest.
Oh, first a bit of background on my treatment relevant to this conversation.
Every third Thursday I get my chemo infusion. On that same Thursday I'm supposed to start taking the capecitabine pills. I take the pills for fourteen days. For the next seven days I'm cancer-drug free, and then the cycle starts again. And in the interest of
And so we begin...
In February, I received an email from my insurer letting me know that in the interest of
I, however, could not call in February as I needed Pharmacy A to send me the drugs associated with my February 24 infusion (moved to Wednesday due to my New Zealand trip) and on February 25 I climbed on a plane and left the country for two weeks.
On March 14 I was back in the country, and called Pharmacy B to transfer my prescriptions and order the capecitabine for my March 17 infusion. The pills didn't show, and trashed by the infusion, I didn't have the energy to call. Worse, on Monday I left for a three day conference, and since I wouldn't be there to claim the pills it wasn't worth calling until the day before my return.
Eventually, though, I'm able to call and I get... Dance Interlude #1. The person I talk to gives me the song and dance about how there's a new federal regulation that requires them to review all prescriptions and blah, blah, blah. But oh look, the release has finally come so give us your address again and we'll get this processed for delivery by Friday.
So I start my pills eight days late.
Jump forward a week and a half, and that brings us to today. I call Pharmacy B to reorder my pills, so I'll have them for this Thursday's infusion. Enter pharmacy clerk #1. Nope, can't do it. We can't refill the prescription because it's "too soon." Nothing that can be done. Call back in a week.
Yeah, no. Can you please connect me to pharmacy supervisor #1? Enter pharmacy supervisor #1. Yup. Nope. Nothing we can do. But wait, I ask, you guys sent the last round to me a week late. I submitted the request on time. Now four weeks ago. Plenty of time should've passed to allow enable you to fill the prescription that I need on Thursday. Nope. Can't renew until next week. Unless you convince your insurance company to approve the "early" renewal, you'll have to wait until next week. But wait, says I, it was your fault I didn't get the last round of pills on time. Shouldn't you have to call my insurance company to explain and convince them to pay? Long, testy back and forth follows, but pharmacy supervisor #1 eventually agrees to call the insurance company.
Perhaps understandably, I decide that I'm less than confident that this will actually happen, so I call the insurance company myself.
Enter insurance claim processor #1. Very friendly, cheery guy who asks what he can do for me. I got two issues, says I. First, I want to complain about, and after venting, try to understand, the decision to move from Pharmacy A to Pharmacy B. Begin Dance Interlude #2. "Better customer service" says insurance claim processor #1. Yeah, I'm not sure you've really accomplished that, says I, and we go back and forth for a bit, and it soon becomes pretty clear that Pharmacy B is cheaper than Pharmacy A (duh), but eventually we move on to issue #2. I want to make sure you're going to approve my refill when Pharmacy B submits it, says I. Clickity clickity click. Ok, says insurance claim processor #1, I'm going to need to transfer you to insurance claim processor #2, who can handle that for you.
And so insurance claim processor #2 comes on the line. What do I need? Refill of my capecitabine so I can start up the next round with Thursday's infusion. Clickity clickity click. Nope. No can do. It's too early. You can't refill it until next week. I again provide the long narrative, in all its gruesome details, explaining that I need to get back in sync with my infusions. Understand, but no can do. Now we wander down various rabbit holes as I try to come to understand the reasoning behind this decision. I get put on hold a couple of times, and each time insurance claim processor #2 comes back to reaffirm, in no uncertain terms, that there is absolutely no way the pills can be sent this week.
Could I perhaps talk to a supervisor, says I. I've already talked to my supervisor, says insurance claim processor #2. You don't understand, says I. I don't want you to talk to your supervisor, I want to talk to your supervisor. Clearly thinking I'm asking for the impossible, insurance claim processor #2 sighs and agrees to see if she can locate a supervisor who will talk to me.
Enter insurance supervisor #1. I start at the beginning, yet again, going through the whole story. And now begins Dance Interlude #3. Now it seems the problem is that sometime between Pharmacy A's last shipment and Pharmacy B's first shipment, Pharmacy A submitted a claim for the round that Pharmacy B eventually shipped. (Don't worry, it gets better.) And while the insurance company had established March 1 as the conversion date from A to B, they nevertheless paid Pharmacy A's claim. But eventually Pharmacy A and/or the Idiot Insurance Company got their act together and Pharmacy A's claim was refunded. And that, explains insurance supervisor #1, is why I can't get a renewal until next week. Hold everything, says I. A claim that was paid and refunded, and thus in a very real way never really happened, somehow prevents a subsequent claim from being paid? Yes, says insurance supervisor #1. Are you freakin' kidding me, says I.
Apparently she was, because now the story changes. Recognizing that I was clearly unimpressed with the Pharmacy A story, now we move to an analysis of the wording on my prescription. Apparently, the fact that my prescription contains fourteen days worth of pills but is described as part of a three week cycle seems to be confusing both Pharmacy B and the Idiot Insurance Company. But, says insurance supervisor #1, if I can call my providers at the SCCA and get them to submit a new prescription, then I can get the pills this week.
At last, a chink in the armor!
To confirm, says I, if my provider rewrites the scrip to say it's a fourteen day dosage, then I can get my pills. Yes. Great, says I, I am totally down with this plan -- except for the part where I have to call my provider. Since I didn't create this problem, I don't think I should be the one to have to chase down the solution. I think you should call my provider to sort this out. Amazingly, after much hemming and hawing, insurance supervisor #1 agrees to make the call.
The light at the end of the tunnel appears.
A few hours later insurance supervisor #1 calls me back to let me know that it's all worked out, and Pharmacy B will be sending my drugs. But, says she (revealing the dark lie at the heart of the whole "to bring you better customer service" bullshit), you may want to give them a call to confirm that they've got your order queued up.
Sigh. Fine. I'll call them.
And so I do. And so enters pharmacy clerk #2 -- who has clearly never heard of me before and can find no sign that an order for my drugs has been submitted for processing. But as we talk and she clickity clickity clicks in the background, she eventually finds evidence that the Idiot Insurance Company has approved the refill which no one has ordered.
And so the order for my drugs is finally approved and processed.
Best health care in the world, baby!
Almost the exact same scenario I went through several times with my son's insulin and test strips renewal. He was left with nothing and I was told to just take him into a walk-in clinic so he could get insulin. At that point I paid for it myself, which I'm telling you is frickin expensive. Love this system!! Really looking forward to the transfer of the test strips now with the new mail order company....
ReplyDeleteHappily, and surprisingly, I have yet to be directed to mail order for my diabetes supplies. I've never been good at planning ahead when it comes to that stuff.
DeleteYou're welcome. :-)
ReplyDelete