I went to get a prescription refilled this evening, after a meeting at work. "I'm sorry, this requires pre-authorization."
So, right there, at the counter in the Pharmacy, I called the company that handles prescription coverage for my health insurance. I won't mention the name, but its initials are Medco. After talking to their computer for a while, I finally got a live person. (After talking with me, I hope she did not have to take a personal day, dissolving into tears, running screaming from the building.)
I was furious. Livid. Fit-to-be-tied. Outraged. (What words could you add to this list?) While civil, I don't think you could say I was polite. I apologized to the person on the other end of the phone, saying that I knew it was not her fault. I knew that she was just doing her job, (and being polite about it). I told her that . . . . . . and then told her how furious/outraged/angry/livid I was about this system. I was ready to occupy something, and it would not be a pretty sight.
And, you wouldn't believe what a nice, mild-mannered, usually calm person I am. Most of the time.
So, I have to call the drug lords of insurance-land to be told a telephone number that I must give to the doctor's office, so that the doctor's office may call it to get a form faxed to them (the Doc's office) that must then be completed and returned to the prescription barons. Then the headless wonders of prescription hell can decide if it's really what I should have, a legitimate drug, a real need, and whether they will pay for it. After all, the doctor's office has so much spare time, and so many extra employees just sitting around. And, the doc doesn't know her arse from a hole in the ground - how could she possibly know what to prescribe for me.
When you go to your doctor, does she routinely give you random, expensive, useless prescriptions usually prescribed for symptoms and ailments that you do not have? Perhaps many doctors do. Do they?
I talked tonight with four different persons at the drug castle. (I apologized and warned them in advance.) The third person with whom I spoke was in the pre-authorization department. Then, he transferred me to a pharmacist in the pre-authorization department. Who only works in the pre-authorization department. They have pre-authorization pharmacists?! Who knew?
This is all to save us money. Pre-authorization departments. Doctor's offices with staff members who do nothing but make calls and file forms with pre-authorization departments. To save us money?
The hilarity of it continues: it was an old, generic drug. Not like the doc is getting pay-offs from the drug company on this one.
Opening a bottle of wine was the best decision of the night. I'm better now. A bit.
13 comments:
My day was pretty much like that, too.
Love :-)
J
Insurance companies now run our lives (or is that ruin our lives). :D
You made me laugh with your comment about "occupy something".
Glad to see your sense of humour is carrying you through this frustrating day!
So many of us have been there. The health insurance industry has created nightmares...since the mission of health insurance is to make money for the stockholders, not to provide medical care or needed prescriptions.
The republicans talked about "death squads" that would ensue if we had Universal Health Care - but the death squads are sitting in the lavish offices of the health insurance companies, only they call them the "Pre-authorization Department".
Walmart would have saved that with their 4 generic skips. :-)
that is indeed sooo frustrating.
Having met you several times, I know you to be meek mannered, mild, passive, deferential, almost St. Francis-like; so I have trouble imagining you like Christ with the Money Changers! But you'll get through--you always do, you know? B.
Oh, try to take the survey at the end of these calls. The last two rep types have hung on the line, one would not hang up so I could go on and take their survey. I just hung up. Love to short circuit the call in order to go to the rep, let me talk to a person, please.
It is situations like this which make me glad about the healthcare system in Ireland and the Uk. The max amount per prescription is 7 pound.
I used to have Optimum Choice insurance and they were the most miserable company ever for trying to get prescriptions filled. They always tried to say that the antidepressants I took back then were actually smoking cessation pills (I've never actually smoked).
I'm in Canada and have a drug plan through my employer (the provincial drug plan only covers seniors and the poor.)
My employer's plan manager sent us a note they were rethinking their approach. It was getting too difficult to manage all these pre-auths so they've simplified the process:
- generics or drugs where no generic exists- copay is 10% - not to exceed $10
- non-generic - when a generic exists - is a 30% copay (you want name brand, you pay for it)
Pre-auth's are now only when the total yearly cost of the drug would be over $10,000.
Of course, the other insurance problem I have is under-insurance. My dental plan covers so little that it might as well be nothing. I need about $2,100 in dental work and the money simply isn't there.
Your company sounds like mine.
A trick that sometimes works in the States is to have an RX filled by a Compounding Pharmacy. This somehow bypasses the Pre-Authorization / Pharmaceutical Insurance company nightmares.
Here our Pharmaceutical Nightmares name is Express-Scripts. If your company implements anything with these people... CHANGE JOBS! Seriously, make it Us, the employees or Them.
Recently, I had this experience.
I call the Compounding Pharmacy, They tell me the RX has expired and they'll call the Dr to get a new one. Done Deal no hassles and they DELIVERED to my door the next day.
I put something through the Nightmare insurance and it's answer 20 questions, then be told I could access my information over the internet (Tried but the history is blank), then I'm told the Rx is expired, AND I'LL HAVE TO CALL THE DR. Then the Dr, calls me back because they can't get the form to fax. I get the form fill it out, fax to my Dr. he signs then faxes it to the Nightmare. 2 days later I get an email saying they've got my order. 5 days later I still have nothing.
Good thing I plan 30 days ahead...
If indeed time is money... then Big Mail order insurance pharmacies save us money how???
And what does being forced to use the big mail order pharmacies do to our local drug stores? What about the familiar pharmacists who have provided such good service to us through the years?
All I can say man is you're not alone!
There usually is a reason for every hoop one has to jump through. I think this hoop was instigated when doctors started getting kick-back from drugs they prescribe. I know you said it was generic, but the fact is that the doctor has to jump through a hoop to be sure he isn't prescribing anything for the kick-back.
Patience is it's own reward.
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