This is going to be a long rant about our insurance company. Feel free to skip it and scroll down to see pics of our adorable kiddos instead!
I don't think I have mentioned this yet, but we recently got Caleb's liver function labs and they are NORMAL!! It took 2.5 years, but his liver has recovered! YEAH!! So now his immunologist wants to try putting him back on the medication that put him into liver failure in the first place. BOO!! (He was WAY overdosed back then though, which I am almost 100% positive that is why he had such an issue with it. But I won't get into that. This rant is about our insurance company/pharmacies, not the doctor's inability to do math...)
I have been on the phone everyday this week trying to get the medication so we can start it. It is a "specialty" drug and there are only 3 pharmacies in the country that carry it. Two weeks ago, the doctor's office faxed the order to one of them (I'll call it Pharmacy A), but our insurance company wouldn't cover the med from them. Of course that company didn't find it necessary to tell the office that and threw away the script.
The following is a "condensed" version of my week spent with the phone attached to my ear....
Since I hadn't heard from them, I called Pharmacy A on Monday and was told that they had no record of Caleb and gave me the name of another pharmacy (Pharmacy B) to call. Pharmacy B told me that they were in fact the correct company and that they would just need the prescription faxed to them and they would contact me once everything was set. I got a call on Tuesday from Pharmacy B telling me that our insurance company had denied the prescription because it wasn't their "preferred pharmacy." So I called the insurance company and they told me that all meds had to be filled through Pharmacy C. Well, I called that pharmacy and was told that they don't even have that medication and that we needed to have it filled at Pharmacy A.
So I informed the doctors office that they needed to re-fax the script to Pharmacy A, since they were indeed the one's who had to fill the medication. Pharmacy A called me the next day, to tell me that they were processing the order but our insurance company was not going to cover the needles and syringes. (This med has to be injected). Of course that set me off again. I called Pharmacy A and asked them why they wouldn't just supply the needles and syringes. How was I supposed to give the medication? The woman looked up Caleb's file and said. "Mam, this prescription has been denied. I am not sure why you weren't notified, but you have to go through Pharmacy B." WHAT?? EXCUSE ME??? So now I am reallypissed mad. By now it was Thursday AM, so I made yet another call to the doctor's office so they could fax another order out.
Pharmacy B called me Thursday afternoon and told me that Caleb's prescription was ready to be filled, but they needed their payment first. I let out a sigh of relief and said, "Okay, how much is it." I knew it wasn't good when she said "I need to put you on hold to make sure this is the correct amount." So she comes back and said, "$1836.00" To which I replied, "For a year?" "No mam, that's the cost for one month." I told her I needed to call the insurance company before we filled it since there is no way we can afford to pay that each month (especially since we are already paying $160/month for his other meds). Plus, 2.5 years ago, we had to pay $50 a month for the same medication. And inside I was sort of "laughing" because the day before I was complaining that we'd have to pay about $40 a month for supplies. That's nothing compared to what the medication is going to cost us! Then I was crying because we were going to have to pay $1876/month just for this one med.
Then I got an automated message on Thursday night saying that Caleb's prescription had been denied and I needed to contact them. I called them back and asked why the lady hadn't told me that earlier in the day when she called wanting me to pay for it. He told me that maybe they weren't notified by our insurance company about the denial yet. At that point I was about ready scream.
The boys and I went to the zoo on Friday AM, but I made a quick call to the office to tell them what was going on. The nurse called Pharmacy B and was told that we need to go through Pharmacy A (in case you're lost, that's the one that had denied us earlier in the week and was the FIRST one that we tried, 2 weeks ago!!). The nurse called me back at the zoo and said that it was all set through Pharmacy A, but the cost was $1836.36. (I love it that this company feels the need to charge the extra $0.36) So I told the nurse there is no way that we can afford this and that they are going to have to write to the insurance company or something if they really want him on it.
And are you ready for this??!! This morning (Saturday), I get an automated call from Pharmacy A saying that they need our payment so they can fill the order. I called them back and asked them how much I had to pay, the lady said "I can check that for you." After a very long pause she says, "Huh. You got a call saying you needed to pay? Well this is telling me that it's too early to refill your prescription. Your insurance company won't allow another refill until July 5th since you had it filled on May 5th." I told her that it was never filled and she said "Well, mam it shows that you filled it on the 5th. But it's not showing that it cleared with the insurance company, that's weird." Let me connect you to another department to get this straightened out." So the next person I talk to tells me that our insurance company isn't going to cover the med if we fill it at this pharmacy and it needs to be filled at Pharmacy C instead. "That's your insurance company's preferred pharmacy." (Remember that one? The one that DOESN'T EVEN HAVE THE FREEKEN MEDICATION??!!)
And every time I have called the actual insurance company this week (at least once a day) to ask them where in fact we really need to go and get this prescription filled and how much our co-pay really is, they transfer me to Pharmacy C. Apparently, the number on the back of our insurance card is just the "health" part of our insurance. And the people at Pharmacy C tell me that they can't access our insurance information. They are "just a pharmacy who fills prescriptions". So everyone is pointing fingers, but no one really knows what the heck is going on. Lovely.
So, that's where we are today. I didn't have the willpower to sit on the phone all day today when clearly it hasn't gotten me anywhere with all of this. And of course our pediatrician is out of the office for the next 2 weeks and the nurse who is "helping" me get this straightend out has let me know several times that she is doesn't get paid enough to deal with stuff like this. Nice huh? I'll be sure to keep you posted....
Here are some (not so good) pics from the zoo. Caleb and his buddy Kenny have been dying to ride the train and we finally gave in this week. I'm still wondering who stole my baby....doesn't Isaac look so old?
I don't think I have mentioned this yet, but we recently got Caleb's liver function labs and they are NORMAL!! It took 2.5 years, but his liver has recovered! YEAH!! So now his immunologist wants to try putting him back on the medication that put him into liver failure in the first place. BOO!! (He was WAY overdosed back then though, which I am almost 100% positive that is why he had such an issue with it. But I won't get into that. This rant is about our insurance company/pharmacies, not the doctor's inability to do math...)
I have been on the phone everyday this week trying to get the medication so we can start it. It is a "specialty" drug and there are only 3 pharmacies in the country that carry it. Two weeks ago, the doctor's office faxed the order to one of them (I'll call it Pharmacy A), but our insurance company wouldn't cover the med from them. Of course that company didn't find it necessary to tell the office that and threw away the script.
The following is a "condensed" version of my week spent with the phone attached to my ear....
Since I hadn't heard from them, I called Pharmacy A on Monday and was told that they had no record of Caleb and gave me the name of another pharmacy (Pharmacy B) to call. Pharmacy B told me that they were in fact the correct company and that they would just need the prescription faxed to them and they would contact me once everything was set. I got a call on Tuesday from Pharmacy B telling me that our insurance company had denied the prescription because it wasn't their "preferred pharmacy." So I called the insurance company and they told me that all meds had to be filled through Pharmacy C. Well, I called that pharmacy and was told that they don't even have that medication and that we needed to have it filled at Pharmacy A.
So I informed the doctors office that they needed to re-fax the script to Pharmacy A, since they were indeed the one's who had to fill the medication. Pharmacy A called me the next day, to tell me that they were processing the order but our insurance company was not going to cover the needles and syringes. (This med has to be injected). Of course that set me off again. I called Pharmacy A and asked them why they wouldn't just supply the needles and syringes. How was I supposed to give the medication? The woman looked up Caleb's file and said. "Mam, this prescription has been denied. I am not sure why you weren't notified, but you have to go through Pharmacy B." WHAT?? EXCUSE ME??? So now I am really
Pharmacy B called me Thursday afternoon and told me that Caleb's prescription was ready to be filled, but they needed their payment first. I let out a sigh of relief and said, "Okay, how much is it." I knew it wasn't good when she said "I need to put you on hold to make sure this is the correct amount." So she comes back and said, "$1836.00" To which I replied, "For a year?" "No mam, that's the cost for one month." I told her I needed to call the insurance company before we filled it since there is no way we can afford to pay that each month (especially since we are already paying $160/month for his other meds). Plus, 2.5 years ago, we had to pay $50 a month for the same medication. And inside I was sort of "laughing" because the day before I was complaining that we'd have to pay about $40 a month for supplies. That's nothing compared to what the medication is going to cost us! Then I was crying because we were going to have to pay $1876/month just for this one med.
Then I got an automated message on Thursday night saying that Caleb's prescription had been denied and I needed to contact them. I called them back and asked why the lady hadn't told me that earlier in the day when she called wanting me to pay for it. He told me that maybe they weren't notified by our insurance company about the denial yet. At that point I was about ready scream.
The boys and I went to the zoo on Friday AM, but I made a quick call to the office to tell them what was going on. The nurse called Pharmacy B and was told that we need to go through Pharmacy A (in case you're lost, that's the one that had denied us earlier in the week and was the FIRST one that we tried, 2 weeks ago!!). The nurse called me back at the zoo and said that it was all set through Pharmacy A, but the cost was $1836.36. (I love it that this company feels the need to charge the extra $0.36) So I told the nurse there is no way that we can afford this and that they are going to have to write to the insurance company or something if they really want him on it.
And are you ready for this??!! This morning (Saturday), I get an automated call from Pharmacy A saying that they need our payment so they can fill the order. I called them back and asked them how much I had to pay, the lady said "I can check that for you." After a very long pause she says, "Huh. You got a call saying you needed to pay? Well this is telling me that it's too early to refill your prescription. Your insurance company won't allow another refill until July 5th since you had it filled on May 5th." I told her that it was never filled and she said "Well, mam it shows that you filled it on the 5th. But it's not showing that it cleared with the insurance company, that's weird." Let me connect you to another department to get this straightened out." So the next person I talk to tells me that our insurance company isn't going to cover the med if we fill it at this pharmacy and it needs to be filled at Pharmacy C instead. "That's your insurance company's preferred pharmacy." (Remember that one? The one that DOESN'T EVEN HAVE THE FREEKEN MEDICATION??!!)
And every time I have called the actual insurance company this week (at least once a day) to ask them where in fact we really need to go and get this prescription filled and how much our co-pay really is, they transfer me to Pharmacy C. Apparently, the number on the back of our insurance card is just the "health" part of our insurance. And the people at Pharmacy C tell me that they can't access our insurance information. They are "just a pharmacy who fills prescriptions". So everyone is pointing fingers, but no one really knows what the heck is going on. Lovely.
So, that's where we are today. I didn't have the willpower to sit on the phone all day today when clearly it hasn't gotten me anywhere with all of this. And of course our pediatrician is out of the office for the next 2 weeks and the nurse who is "helping" me get this straightend out has let me know several times that she is doesn't get paid enough to deal with stuff like this. Nice huh? I'll be sure to keep you posted....
Here are some (not so good) pics from the zoo. Caleb and his buddy Kenny have been dying to ride the train and we finally gave in this week. I'm still wondering who stole my baby....doesn't Isaac look so old?
1 comment:
Wow Trisha, I just can't imagine your frustration! You have a lot more patience than I....I am pretty sure I would have thrown the phone out the window a few times!!
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