Name: margalit
Location: Massachusetts, United States Professional writer, educational advocate, opinionated ultra liberal mother of 18 year old twins, living life in the slow lane due to hypertrophic cardiomyopathy, congestive heart failure, and diabetes.

email: margalitc at yahoo dot com

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Tuesday, March 10, 2009

Aaahhhh, relief

The story of my health insurance crisis, by the numbers.

8 --The day in February (not March, FEBRUARY) that my doctor first sent in the pre-authorization for my medication.

17-- The day in February that I picked up my last prescription for my medication and found out that the pharmacy had only filled a partial script because the health insurance hadn't yet decided on the pre-authorization.

37.5-- The smallest dose of Effexor manufactured.

37.7-- The maximum amount of Effexor the health insurance allowed without pre-authorization.

122.5 -- The dosage I've been on for several years that the health insurance has always covered with no problem until January. Damn their formulary.

5-- The first time in March I went to the pharmacy to refill my partial prescription and found that the health insurance company had not yet done a thing about the pre-auth.

6--The second time in March I went to the pharmacy to refill my partial prescription and found that the health insurance company had not yet done a thing about the pre-auth.

8 -- Number of phone calls to CVS I made trying to get my prescription refilled and couldn't.

17 -- The number of phone calls to various and sundry people and departments at my insurance company trying to find out what the hell was taking them so long to get my pre-auth done.

6-- The number of phone calls to and from my doctor's office where I found out that my doctor is out of the country and couldn't do a second pre-auth, the nurses couldn't do it without the doctor, and nobody thought to ask if ANOTHER doctor could cover the pre-auth so I could get my drugs.

1-- Phone call to another doctor in the practice to explain what was going on and to have her write another pre-auth which she did immediately. YEAH Dr Okun! We love you!

2-- Number of phone calls to the nurse today after pre-auth was sent wondering why it still hadn't been taken care of.

1-- Number of phone calls nurse made to insurance co to scream at them about how irresponsible it is to leave a patient hanging for more than a month when by law they have to make decision within 48 hours.

1-- Phone call today to insurance to find out why I still couldn't even get a partial prescription and to find out that, oh, I COULD get a partial prescription if I just contacted CVS.

3-- Phone calls today to CVS to discuss partial prescription which insurance company approved but CVS wouldn't try to put through until I went freaking ballistic on them, insisted on speaking to head pharmacist who speaks English (all of our CVS pharms are students at the Mass College of Pharmacy and evidentally that school does not require English skills as part of their training.) Once I got head pharm, he ran prescription through and VOILA... I could come and get a partial prescription.

7-- Number of hours I spent today on phone before I finally got the prescription.

1-- Complaint to the Insurance Commisioner about insurance company taking over a month and still not approving my pre-auths.

57-- Cost of a 3-day supply I paid that is not reimbursable for 9 pills over the weekend.

460-- Cost of 30 day supply of 37.5 pills (30 of them) that insurance company wanted me to pay out of pocket. When I explained that this was actually a 10-day supply and I couldn't afford to shell out $1300 for medication that they SHOULD be covering, they were shocked! Shocked, I say.

3-- Number of pre-auth forms my doctor's office sent to insurance company that they did not act on.

5--Number of twitters where I swore that health insurance is EVIL.

8-- Number of months before my open enrollment period where I can ditch this health insurance and go with a company a bit more on the ball.

11-- Number of pages in my phone call log I wrote just on this stupid problem. Eleven freaking pages of phone numbers, confirmation numbers, names of customer service reps, times of calls, and synopsis of each call.

3-- Number of Effexor capsules I swigged down at the pharmacy counter with my sugarless Arizona Iced Rasberry Tea.

3-- Number of hours it took until I felt regular again and my panic disappeared.

1-- Number of times my defibrillator went off due to irregular heart beat without medication.

2-- Number of hours I napped after my heart calmed down.

It's been a really exciting week since I started this whole deal. From March 5th to today, March 11th, I have spent the majority of time time dealing with this one problem. I don't think it's right for any company to have the patient do all of the phone calling between the doctor, the insurance company, and the pharmacy. Why they cannot talk to each other is beyond me, and why the insurance company says that they cannot make outgoing calls is just insane. If they can't contact their clients, what is the point of being a customer service rep? They're supposed to sit and wait for someone to call them, but they can't call them back? Does this make any sense at all.

I hope the Insurance Commissioner fines them for sitting on this pre-auth for more than a month. I really do.

And if I have to do this again next month, I swear it, I'm going to go postal. Since January I've been bitching about this damn prescription, I have't gotten one full dose yet, and I've paid through the nose for co-payments that I should have to make. I'm so sick of this. It's exhausting.

Insurance is EVIL.

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Blogger Rhea said...

It's like they sit around dreaming up ways to screw with us.

11/3/09 8:54 AM  
Blogger Daisy said...

Not to mention that your illness is getting worse while you're wasting time and energy on the phone...

12/3/09 6:55 PM  
Blogger margalit said...

It's the 13th and guess which insurance company has still not acted upon the pre-auth? That would be my insurance co.

13/3/09 6:01 AM  

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