health care industry woes
Jul. 23rd, 2004 04:14 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
sevupdate: I was *just* about to post this when I got a phone call; the benefits rep at the organization through which I get my health insurance also believes this is ridiculous and she will fix this so that I don't have to actually do *anything* more; she will make sure all the right things happen. This is quite the unexpected reprieve. I'm posting it anyway, well, because now it's *funny* in a "this has gotta be a joke, right?" kind of way.
I used to think I had this kind of experience with insurance because I must've just had crappy health insurance. Now that I'm on the same plan as a number of other people I know -- who haven't had these problems -- I begin to suspect that the healthcare industry is out to get me.
I'm on a maintenance prescription. This means that every day, I take some pills. I've been doing this for over a year now and might very well be doing it for the rest of my life.
In April, my health insurance informed me that my maintenance prescriptions must be filled via a specific home-delivery pharmacy service and that I can't refill them at the local brick-and-mortar pharmacy anymore. I followed the directions I was given, which involved going to a website, finding that prescription in a list of my current prescriptions, and clicking a button. Easy as pie, right?
Nearly three weeks later, April is done with; now it's May. I still don't have my pills. I'm really close to being out -- the insurance said this process would take about two weeks, so I was not really prepared to wait three. I get a call from the home-delivery pharmacy who says they can't send me my pills because they can't seem to contact my doctor. "Why would you need to call my doctor?" "We always need to contact the doctor when a new prescription comes in." "This is the same prescription I've been on all along." "It's a new prescription from our perspective." (this conversation took fifteen minutes, not four sentences. But that was the closest thing to an explanation I was able to extract from them.
Note that in the case of prescriptions, unlike with contact lenses, pharmacists are not required by law to contact the prescribing doctor for verification before filling a prescription; it is normally assumed that the signature on the prescription pad is sufficient.
Well, my doctor travels quite a bit, and a little under two weeks before this phone call (one week after I tried to refill the prescription), she'd left town. It's no surprise to me that they can't get a hold of her. However, they've got no explanation whatsoever why they waited a week before they tried calling her in the first place. If they'd called her even four days after I'd gone to that website and clicked that button, they'd have been able to talk to her.
Several more phone calls between me and the pharmacy ensue, over the course of a couple of days, before one of the people I'm talking to mentions that they had spoken to another doctor who was handling my doctor's practice while she was gone. That they'd spoken to him two days before, before they called me the first time.
So, I reiterated that yes, I knew she was out of town and said that yes, of course they should coordinate with the guy covering her practice while she was gone.
They knew she was out of town before they ever called me. Because they had already talked to the guy who was supposed to be handling this stuff while she wasn't there. Yet instead of just getting on with things they waited until they could get me on the phone and say ... what? They weren't asking me if it was okay for them to talk to and work with this other doctor, or else they'd have said that in the first place. Apparently they just didn't want to do anything until they made sure I knew that my doctor was out of town. Or something. Um, what? (the closest thing to a plausible explanation I can imagine: the person who initiated the call to me was not the same person who talked to the other doctor. After two days, there was one pharmacist working on both the talk-to-me and the talk-to-the-doctor avenue of inquiry, and only at that point did anybody realize both of these things were happening at once. Or perhaps there is a time lag between information being added to an account and it being accessible to the people I'm talking to.)
After these few days of phone calls, they asked me if I had enough pills to last me 'till after my doctor got back into town. No. I did not. I would run out two or three days before she got back. They said they'd go ahead and fill the prescription based on what they got from the other guy...and nobody could explain to me why they hadn't gone ahead and done that in the first place. No, I could not pay them for expedited shipping; I can only do that at the time I order the prescription. Based on their estimated shipping times, if they shipped me my pills the very next day, I'd receive them exactly the same day I would run out of my existing supply.
Just in case, I decided to cut my consumption by a third, because from previous discussions with my doctor, it's better for me to miss a pill here and there than to miss several pills in a row.
Good thing I did; it took them several more days to actually ship the prescription to me.
And then, when it arrived, it was a three-month-supply, no refills.
So, back to the phone. At this point, I'm talking to a customer service rep, instead pharmacists like I had been previously.
My prescription was refillable until January of 2005! No, she says. The prescription says nothing about refills. I had that prescription *in my hand*. I saw what it said. All the bottles from the previous pharmacy say "refills until 01/2005." Well, the prescription they got said nothing about refills. And then I discover: this was not the prescription my doctor wrote for me. This prescription was written by the other doctor, the one that they talked to while my doctor was out of town.
Much to my surprise, they did not just tell the guy the prescription and then let him say, yes, that sounds fine. What they did was describe in the vaguest terms possible what the prescription *might* say, and then made him write another prescription that he could vette. *I* know they had the original prescription at some point, but apparently the new one overwrote it, as there was no indication in their system that there had ever been any prescription other than the one written buy the person who was handling my doctor's emergencies while she was gone.
Note that this means I was getting a prescription written for me by someone I've never met. In general, that sort of thing is illegal; the FDA and DEA require that an individual be examined in person by the prescribing physician before receiving controlled substances from a pharmacy. And the prescribing physician in this case was someone whose name I don't even know. I assume that there's some loophole or another that means they can do business like this. They're not a small mail-order pharmacy; they're a ginormous online pharmacy that is the sole provider of maintenance prescription fulfillment for more than one health insurance company -- including mine, which has over a million people enrolled. So I assume that they aren't breaking the law.
So, here I've got a three-month supply. It took three-and-a-half weeks from the time I requested it until the time it showed up. So, next time, I should request the prescription four weeks ahead, right?
No, the customer service rep tells me. I can't do that; if I request the prescription more than two weeks in advance, the insurance will reject it.
But, what do I do for that extra week and a half? I'm supposed to get a separate prescription for fourteen days from my doctor, and fill it at the brick-and-mortar pharmacy...at my own expense.
Every time? Well, this shouldn't happen every time; I really should ask my doctor for a prescription I can refill instead of submitting a new prescription every three months. Gee, you think?
I start winding down the call because I'm reaching the point of "too angry to verbalize." At that point she says: Her job is to ensure 100% satisfaction on my part, and am I satisfied? I sputter in disbelief, and all she does is repeat herself.
I explain that what I thought I was hearing was:
1. I have no choice but to use this service if I want my meds covered under insurance.
2. She believes that the service did exactly what it was supposed to do, and there's nothing it could have or should have done differently.
3. If, as a result waiting three and a half weeks to receive this bottle of pills labeled "no refills" (despite the prescription from my doctor saying 'refills until 1/15/2005') I decide to send in the next prescription a month early in hopes of getting the next bottle before this bottle runs out, the insurance will turn down the request because it's "too soon", and I need to wait until I've got only 14 days worth of pills left, because that's how long they insist it takes to fill prescriptions using this service.
4. There is absolutely nothing in my power I can do to prevent this from happening again.
5. There is absolutely nothing they are willing to do to prevent this from happening again.
She agrees with each of those points.
So, no, I do not believe this is reasonable and I am not satisfied.
She repeats that her job is to ensure 100% satisfaction on my part. And does not answer any request I make for her to actually *do* anything other than to repeat her meaningless little comment.
Fine. The thing that will increase my satisfaction at this call is if she makes absolutely sure that my experience -- and my feedback that I think this is ridiculous -- gets to the appropriate ears. She says she'll
do that. And now, am I 100% satisfied?
I suspect that she must have some post-call form to fill out.
I go through it with her again. So, when I finally do get to the point where it's late enough that the insurance *will* fill my prescription, what do I do?
She tells me, and I repeat back to her just to make sure I understand: Get a three-month refillable prescription from my doctor. Go to that website and fill the prescription. Wait two weeks and I should have my pills.
Okay, fine. I've got my pills and I know what to do next. I tell her that she seems to have done all she can or will do towards my satisfaction, and end the call.
A bit under two weeks ago, I got a note from my insurance -- this is an automated reminder that it's time for you to go get another prescription from your doctor. I look at the calendar. Nearly six weeks until I'm supposed to run out, not two. Which is good, because my doctor had been tinkering with my dosage, and means my "three month supply" was going to run out sooner than three months. Okay, too bad that note arrived right *after* my last doctor's appointment. I see her every two weeks; if it takes three-and-a-half-weeks to get me my prescription again, I'm going to be paying for nearly a week out of my own pocket. Which, over the last seven or eight weeks, I'd convinced myself wasn't a disaster. Since they'd switched me to generics, a week's supply was more like $20 than $60, which is a definite improvement.
Anyway, at my next appointment, I get another prescription. And the unwelcome news that my doctor will be out of town for our next appointment, so it gets pushed out to three weeks from now. Wait, what does that mean if they need to contact her about this stupid prescription again? Well, they'd better do it before she leaves on the 28th.
I visit the website that the customer service person had told me to visit, during that phone call in May. I click on the link that says "New Prescription." On that page there's two sections. The first one is entitled, "If your doctor has already written a prescription for you, you can:" Beneath the title, there is a list. The list has exactly one item in it. This item says "Mail the prescription and a form to..." and provides a snail-mail address.
Um, what?
That wasn't part of the directions. Why did I ask twice and repeat back the instructions just to make sure I understood? How did they manage to skip the part about US Postal mail?
Faxing it is not an option.
They're going to receive the paper copy of this prescription Monday at the earliest. If they don't call my doctor by Tuesday, I'm going to have exactly the same problems this time as I did the last time.
This is a stupid game and I don't want to play anymore.
I used to think I had this kind of experience with insurance because I must've just had crappy health insurance. Now that I'm on the same plan as a number of other people I know -- who haven't had these problems -- I begin to suspect that the healthcare industry is out to get me.
I'm on a maintenance prescription. This means that every day, I take some pills. I've been doing this for over a year now and might very well be doing it for the rest of my life.
In April, my health insurance informed me that my maintenance prescriptions must be filled via a specific home-delivery pharmacy service and that I can't refill them at the local brick-and-mortar pharmacy anymore. I followed the directions I was given, which involved going to a website, finding that prescription in a list of my current prescriptions, and clicking a button. Easy as pie, right?
Nearly three weeks later, April is done with; now it's May. I still don't have my pills. I'm really close to being out -- the insurance said this process would take about two weeks, so I was not really prepared to wait three. I get a call from the home-delivery pharmacy who says they can't send me my pills because they can't seem to contact my doctor. "Why would you need to call my doctor?" "We always need to contact the doctor when a new prescription comes in." "This is the same prescription I've been on all along." "It's a new prescription from our perspective." (this conversation took fifteen minutes, not four sentences. But that was the closest thing to an explanation I was able to extract from them.
Note that in the case of prescriptions, unlike with contact lenses, pharmacists are not required by law to contact the prescribing doctor for verification before filling a prescription; it is normally assumed that the signature on the prescription pad is sufficient.
Well, my doctor travels quite a bit, and a little under two weeks before this phone call (one week after I tried to refill the prescription), she'd left town. It's no surprise to me that they can't get a hold of her. However, they've got no explanation whatsoever why they waited a week before they tried calling her in the first place. If they'd called her even four days after I'd gone to that website and clicked that button, they'd have been able to talk to her.
Several more phone calls between me and the pharmacy ensue, over the course of a couple of days, before one of the people I'm talking to mentions that they had spoken to another doctor who was handling my doctor's practice while she was gone. That they'd spoken to him two days before, before they called me the first time.
So, I reiterated that yes, I knew she was out of town and said that yes, of course they should coordinate with the guy covering her practice while she was gone.
They knew she was out of town before they ever called me. Because they had already talked to the guy who was supposed to be handling this stuff while she wasn't there. Yet instead of just getting on with things they waited until they could get me on the phone and say ... what? They weren't asking me if it was okay for them to talk to and work with this other doctor, or else they'd have said that in the first place. Apparently they just didn't want to do anything until they made sure I knew that my doctor was out of town. Or something. Um, what? (the closest thing to a plausible explanation I can imagine: the person who initiated the call to me was not the same person who talked to the other doctor. After two days, there was one pharmacist working on both the talk-to-me and the talk-to-the-doctor avenue of inquiry, and only at that point did anybody realize both of these things were happening at once. Or perhaps there is a time lag between information being added to an account and it being accessible to the people I'm talking to.)
After these few days of phone calls, they asked me if I had enough pills to last me 'till after my doctor got back into town. No. I did not. I would run out two or three days before she got back. They said they'd go ahead and fill the prescription based on what they got from the other guy...and nobody could explain to me why they hadn't gone ahead and done that in the first place. No, I could not pay them for expedited shipping; I can only do that at the time I order the prescription. Based on their estimated shipping times, if they shipped me my pills the very next day, I'd receive them exactly the same day I would run out of my existing supply.
Just in case, I decided to cut my consumption by a third, because from previous discussions with my doctor, it's better for me to miss a pill here and there than to miss several pills in a row.
Good thing I did; it took them several more days to actually ship the prescription to me.
And then, when it arrived, it was a three-month-supply, no refills.
So, back to the phone. At this point, I'm talking to a customer service rep, instead pharmacists like I had been previously.
My prescription was refillable until January of 2005! No, she says. The prescription says nothing about refills. I had that prescription *in my hand*. I saw what it said. All the bottles from the previous pharmacy say "refills until 01/2005." Well, the prescription they got said nothing about refills. And then I discover: this was not the prescription my doctor wrote for me. This prescription was written by the other doctor, the one that they talked to while my doctor was out of town.
Much to my surprise, they did not just tell the guy the prescription and then let him say, yes, that sounds fine. What they did was describe in the vaguest terms possible what the prescription *might* say, and then made him write another prescription that he could vette. *I* know they had the original prescription at some point, but apparently the new one overwrote it, as there was no indication in their system that there had ever been any prescription other than the one written buy the person who was handling my doctor's emergencies while she was gone.
Note that this means I was getting a prescription written for me by someone I've never met. In general, that sort of thing is illegal; the FDA and DEA require that an individual be examined in person by the prescribing physician before receiving controlled substances from a pharmacy. And the prescribing physician in this case was someone whose name I don't even know. I assume that there's some loophole or another that means they can do business like this. They're not a small mail-order pharmacy; they're a ginormous online pharmacy that is the sole provider of maintenance prescription fulfillment for more than one health insurance company -- including mine, which has over a million people enrolled. So I assume that they aren't breaking the law.
So, here I've got a three-month supply. It took three-and-a-half weeks from the time I requested it until the time it showed up. So, next time, I should request the prescription four weeks ahead, right?
No, the customer service rep tells me. I can't do that; if I request the prescription more than two weeks in advance, the insurance will reject it.
But, what do I do for that extra week and a half? I'm supposed to get a separate prescription for fourteen days from my doctor, and fill it at the brick-and-mortar pharmacy...at my own expense.
Every time? Well, this shouldn't happen every time; I really should ask my doctor for a prescription I can refill instead of submitting a new prescription every three months. Gee, you think?
I start winding down the call because I'm reaching the point of "too angry to verbalize." At that point she says: Her job is to ensure 100% satisfaction on my part, and am I satisfied? I sputter in disbelief, and all she does is repeat herself.
I explain that what I thought I was hearing was:
1. I have no choice but to use this service if I want my meds covered under insurance.
2. She believes that the service did exactly what it was supposed to do, and there's nothing it could have or should have done differently.
3. If, as a result waiting three and a half weeks to receive this bottle of pills labeled "no refills" (despite the prescription from my doctor saying 'refills until 1/15/2005') I decide to send in the next prescription a month early in hopes of getting the next bottle before this bottle runs out, the insurance will turn down the request because it's "too soon", and I need to wait until I've got only 14 days worth of pills left, because that's how long they insist it takes to fill prescriptions using this service.
4. There is absolutely nothing in my power I can do to prevent this from happening again.
5. There is absolutely nothing they are willing to do to prevent this from happening again.
She agrees with each of those points.
So, no, I do not believe this is reasonable and I am not satisfied.
She repeats that her job is to ensure 100% satisfaction on my part. And does not answer any request I make for her to actually *do* anything other than to repeat her meaningless little comment.
Fine. The thing that will increase my satisfaction at this call is if she makes absolutely sure that my experience -- and my feedback that I think this is ridiculous -- gets to the appropriate ears. She says she'll
do that. And now, am I 100% satisfied?
I suspect that she must have some post-call form to fill out.
I go through it with her again. So, when I finally do get to the point where it's late enough that the insurance *will* fill my prescription, what do I do?
She tells me, and I repeat back to her just to make sure I understand: Get a three-month refillable prescription from my doctor. Go to that website and fill the prescription. Wait two weeks and I should have my pills.
Okay, fine. I've got my pills and I know what to do next. I tell her that she seems to have done all she can or will do towards my satisfaction, and end the call.
A bit under two weeks ago, I got a note from my insurance -- this is an automated reminder that it's time for you to go get another prescription from your doctor. I look at the calendar. Nearly six weeks until I'm supposed to run out, not two. Which is good, because my doctor had been tinkering with my dosage, and means my "three month supply" was going to run out sooner than three months. Okay, too bad that note arrived right *after* my last doctor's appointment. I see her every two weeks; if it takes three-and-a-half-weeks to get me my prescription again, I'm going to be paying for nearly a week out of my own pocket. Which, over the last seven or eight weeks, I'd convinced myself wasn't a disaster. Since they'd switched me to generics, a week's supply was more like $20 than $60, which is a definite improvement.
Anyway, at my next appointment, I get another prescription. And the unwelcome news that my doctor will be out of town for our next appointment, so it gets pushed out to three weeks from now. Wait, what does that mean if they need to contact her about this stupid prescription again? Well, they'd better do it before she leaves on the 28th.
I visit the website that the customer service person had told me to visit, during that phone call in May. I click on the link that says "New Prescription." On that page there's two sections. The first one is entitled, "If your doctor has already written a prescription for you, you can:" Beneath the title, there is a list. The list has exactly one item in it. This item says "Mail the prescription and a form to..." and provides a snail-mail address.
Um, what?
That wasn't part of the directions. Why did I ask twice and repeat back the instructions just to make sure I understood? How did they manage to skip the part about US Postal mail?
Faxing it is not an option.
They're going to receive the paper copy of this prescription Monday at the earliest. If they don't call my doctor by Tuesday, I'm going to have exactly the same problems this time as I did the last time.
This is a stupid game and I don't want to play anymore.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
on 2004-07-23 04:35 pm (UTC)Fortunately, his situation isn't such that this is life-threatening ... but I know people for whom it would be, and that scares the hell out of me.