Sylken Whyspers (softlywhispered) wrote in bad_service,
Sylken Whyspers

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Doctors & Insurance companies.. How I loathe you.

This JUST happened to me:

Back on the 17th of January, I went in to pick up my usual monthly medications. I have just switched over to new insurance and handed them the new card. Everything was fine but one drug. The drug I need to keep headaches and seizures away. The pharmacy at Target was very cool. They said they would contact the Insurance company who would contact my doc and get the ball rolling for re-authorization, and it should take a week. Not a problem, I had about a weeks worth of the pills left, so that should do me fairly well.

A week goes by and I hear nothing. That Monday, I go into the Pharmacy and I check with them. They did what they could, I need to call my doctor and make sure they held up their end of the bargain. So instead, I drop by my doctors, explain the situation, drop off my new insurance card, just in case that they didn't have it already and ask them to double check. "No problem, it will be done in the hour." And I go on my merry way, believing that it will all be copacetic.

A few days go by, my supply of this blessed drug is nearly gone, I have 2 days left, and I have heard nothing. I check with the pharmacy once more, they say that they've heard nothing. They re-fax the info over to the doctors, I call the doctors. The doctors assure me that they have contacted the insurance company and that it should be taken care of in... 7-10 days.

I run out of my medication. My husband starts to worry, because as the brain chemistry drops, the migraines come on and I become a real bear to live with. We're in the middle of a move, and the stress is really mounting, I am BARELY holding it together. A few days pass, and he goes to the pharmacy, they still haven't heard anything, but they loan him 6 pills, 3 days worth of medication, and I make that stretch out over 6 days, half doses but it's better than nothing, right? Not so much.

Monday, I call the doctor, I check with them and say that I know it's been a week but I still haven't heard anything from them, from the insurance company And the pharmacy hasn't heard either, could they please give me an update. I leave that message on their answering machine, I also ask for samples of said drug, Topomax. I get a call back from the Doc's nurse, She tells me that they don't have samples, as they don't get them any more. That they turned in the paper work, but there is no guarantee that it will be approved by the insurance anyway, and that I should pay out of pocket ($599.00 for the RX) until I hear from them, if I'm worried. I could call the insurance company on my own to see as well.

I choose Option C. I call the insurance company and go through 3 operators until I get a Resolution Specialist, She is quick to talk over me, telling me they've not gotten anything from my doctor. Not letting me explain that the doc has said that they called that day to check on the process and that the doc said that it was being processed.. bwah. So, in the mood I was in (and mind you, 15 years of customer service work, I didn't lose my temper) I asked for a supervisor.

The Supervisor I got was -very- helpful, she is SO not a suck on any level. She listened, she understood and went over everything that she had on her file. She showed that their company sent out a fax on the 17th (likely when they got the info from the pharmacy) and again on the 26th, when they hadn't heard from the doc's office. There was nothing else from the doc's on file. She understood my panic when I explained that it had nearly been a week since I took my medication and that I was starting to feel the ill effects from my medication not being there to even me out. She took it upon herself to call my doctors office, because apparently there was a HUGE communication break down between Doc and Insurance co.

In the meanwhile, I too called my Doctors office, I left yet another message, regarding having spoken to the insurance company, asking why I had been told that it was in process when the insurance co had no record of it. To please get back with me on that. Of course I heard nothing back from the doc's office.

However at 4:30 pm, when I was fully out of spoons for the day, when I was dragging home after cleaning out the old place and just wanted to crawl into bed. It was the Supervisor from the insurance company. She told me that I was good to go. She'd finally gotten a response from the doctors, they'd faxed her the necessary paper work and that my medication was approved. The pharmacy would have it. And by god they did.

2 days back on my Topomax and I already feel the difference.
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