Shannon (sunk) wrote in bad_service,

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Adventures in "Prior Authorization"

When I was 18 (eight years ago) I was diagnosed with Social Anxiety Disorder. (Actually, doctors had told me I had it before, but I only got an "official diagnoses" at 18.) I've been on Zoloft on and off for the past five years (mostly on, off when I forget to take it), and it helps immensely. After I aged out of my father's insurance, I changed doctors, got an Rx, and continued with the Zoloft, covered by my current insurance. (I've also been diagnosed with Obsessive Compulsive Personality Disorder [not to be confused with OCD], and while not officially on Zoloft for said OCPD, it does help with that as well.)

Until today. I went to my normal pharmacy to pick up said Zoloft and was told it was no longer covered without the dreaded "prior authorization." After fighting with my insurance (unsuccessfully) to get a certain steroid covered after my inverted papilloma surgery this past December, I knew I'd have some hoops to start jumping through. The cost without coverage would only be $29, not a major amount, but, thrifty as I tend to be, if I can get it covered, I want to do it that way. Once home, I called my doctor's office. A member of his staff told me that my insurance company recently "overhauled" what they covered, and the requirements for said coverage. In my case, with Zoloft, they "almost certainly" won't cover it unless I go see a psychiastrist and get the prescription from him/her. Even so, she said, she'd try to see if she could talk to said insurance. "Don't get your hopes up, though," she said. She advised me to call my insurance company directly.

After a minor freak-out at the prospect of going to a new doctor, one who would poke around my head, I called said company. The first woman with whom I spoke, Lisa, told me I "definitely" needed to see a psychiastrist, not only for the prescription but because "it would really help." Well, thanks, random insurance person, but I've tried the psychiatrist thing before and I don't respond well to it at all, so... no. She then asked if I was taking Zoloft for "anxiety and depression or just depression." To this, of course, I said "er, neither of those; just social anxiety. No depression." She came back with "Well, there's always depression." "Um, what?" said I. "Well, social anxiety and depression always occur together. Depression causes anxiety; it's why people are anxious." Really, now. I'm actually pretty non-depressed; I just can't deal with people. After telling her this and mentioning that I was uncomfortable with the discussion (I wasn't, really, but I didn't want to go the "you really need to stop stupid things" route), she placed me on hold to "see what she could find out."

10 minutes of crappy hold music later, she told me she'd transfer me to another department (she never said which one), and added that she "really hopes" I "get the right treatment." The next woman, Martha, was actually helpful (turns out said insurance generally does cover it, they just need my PCP to fill out a few more forms or something?), but I can't get over Lisa. Calling all these people today is bad enough (talking on the phone is awful for me), but to be lectured over my choice of treatment, and then to insist that because I have some people-issues, I'm automatically depressed?

Hindsight being 20/20, I wish I had gotten something more than the name "Lisa" from her, so I could possibly call back file some sort of complaint. Having never worked in customer service (that'd be my own personal hell, heh), I have no idea if there's any way said company would be able to determine which person I'd spoken to without more than a first name. Alas.

(ETA: I probably should make it clear that the b_s I'm ranting about is not really that of the insurance company, though PAs are annoying enough, but that of Lisa and her unwanted and unwarranted... I don't even know what to call it. Advice? Lecture?)
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