Wednesday, November 10, 2010

"Oma" and the terrible horrible no good very bad day

Those of you of a certain age will understand the reference to the fabulous book by Judith Viorst.  You probably should read it to your kids -- or your grandkids.  Well, I had a day that could rival any of Alexander's.  If you are among those who think that health care in this country is just hunkie-dorry, read no further.  You will not like what I have to say.

Yesterday, I visited my new doctor for a blood pressure check.  My health history is not important here.  I am a pretty healthy 65-year-old who has a family history of high blood pressure.  My high BP has been treated for about 20 years.  My new doc decided he wanted to try a different med since my pressure (in his office) registered 167/84.  Not good.

Doc said let's try the new med for 30 days and then see how it goes.  Sounds good to me.  Normally, my meds are ordered over the Internet for a 90-day supply.  With by BP so high, I wanted to start on the new med as quickly as possible.  So, off I went with a brand new prescription for Lotrel, a pretty common BP med, to a VERY mainstream discount pharmacy.  Dropped off the prescription.  Pharmacy called me two hours later to say that they could not get approval from my insurance company for the prescription.  As best that I can reconstruct the circumstances, here is my take:
  • I was covered by this same insurance company under my retirement benefit until I was eligible for Medicare.
  • I was eligible for Medicare on 9/1/10.
  • I elected to stay with the same provider.
  • I have processed doctor benefits under my new plan.
  • I have received 90-day drug benefits under my new plan through their mail order pharmacy.
  • Through some kind of computer glitch, on-site pharmacy requests are being rejected.
  • My online profile shows that I am under two plans:  my new Medicare plan and my old "retirement" benefit plan (which I am really not eligible for any more) --- THIS IS PROBABLY THE PROBLEM.
I called my "Field Representative" last night and explained the situation to her.  She said she would work on it "tomorrow" (i.e., today) and said that I had the option to pay for the prescription and then put in a claim for reimbursement.

Trusting that my representative would help me out, I did nothing until 11 a.m. today.  At that time, I contacted my "provider" by telephone and went through a 20-minute phone conversation the end result of which was confirmation that I was (1) fully enrolled and (2) entitled to receive pharmacy benefits and (3) this prescription should cost me $7.

I determined that perhaps the pharmacy was at fault.  I drove to the pharmacy and took possession of the doctor's script and drove to another pharmacy that had never seen me before!  Guess what?  Same thing happened.  They could not get the prescription approved through the computer system.  After spending at least 15 minutes on the phone with my "provider", they came to a dead end.  The pharmacy was told that they were inputting the correct information but still my prescription would not go through as approved.  My "provider" suggested that the problem was with the pharmacy's software.  Hmmmm .... two different pharmacies, two different software systems, and still the same problem?  Doubt it...

I paid the $56.07 in order to start on the new medication.

I came home and placed another call to my field representative.  At this point, she has not called me back.

So, I believe I am the victim of some kind of computer glitch.  I know this will work out, but should I have to go through this?  What if my condition were more severe?  What if I were less able to deal with these frustrations?  What if I didn't understand the Internet?  What if I didn't know how to use online systems?  What if I were 90 instead of 65?

I won't name names today --- but I will if this is not resolved.

You think my blood pressure was under control today?  Not likely.

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