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Thread: Red Tape Rant!!!

  1. #1

    Red Tape Rant!!!

    Ok...here goes my newest saga...

    Firstly, for those of you who do not know, I am not SCI, but have a birth defect of hip/arthritis. I stay here at CC to meet new friends and to hang on to the friends I have here...

    Anyhow...

    I take celebrex for my arthritis/inflammation. And my insurance co. requires a prior authorization before they pay their part of it.

    I get the meds in 90 day supply.

    So...my most current authorization expires on 10-12-09.

    So...I was not sure of the date, and called the insurance co. yesterday.

    The girl there told me that they would only pay for ONE month's supply, since it expires in mid Oct...and that would kick me into paying monthly prices instead of the discounted quarterly prices.

    And that I had to call my Dr. this morning.

    So, I get permission from supervisor to leave department and go call the Dr.

    Dr's office would not even talk to me, but referred me to the pharmacy, saying that they had to fax info to them before they could process the prior authorization.

    So, I spent $1.50 to get information to get drugstore's number. Called them, and they were like why are you calling us? (but nicely said)...

    Now...at that point, my blood is beginning to pretty much boil.

    I start into my story and when i get to the part about buying one month and then the other months later, the pharmacy worker just stopped me...and said, "First, it is not legal for us to change the way a prescription is written, and this is for a quarterly
    supply only...so that is the only way you can get this medication, quarterly, not monthly. Anything else is illegal."

    Then she said, let me check something...and lo and behold, the order could be processed as it was, and I picked up my medicine, and paid the quarterly price for a quarterly supply, and all is well....I THNK...sigh...

    Talk about the run-around...and that is the short version...

    WHY does communication break down like this?

    What has happened to common sense?

    I even told the girl at the ins.co. that a birth defect was NOT like breaking an arm...it was NOt going to heal itself...

    I also told her that I was not going to take 6 celebrex per day and pray for a heart attack! sighhhhhh...

    Comments???

























    '.

    I said, well,

  2. #2
    Senior Member
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    Sorry you had to deal with this nonsense. It seems like dealing with almost anything health realated is a nightmare. My own doc suddenly won't accept emails or phone calls unless they go through the front desk, which is staffed by a bunch of morons who rarely even remember to tell her I called. It is endemic, but I am sorry for your frustration. My prescription for frustration usually involves Ben and Jerry's.

  3. #3
    Senior Member
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    The run around between insurance,drs & the pharmacy sucks.Nobody really cares about their job anymore & the blame is either yours or another parties.Every once in awhile you find someone that does & I usually glorify them to their manager,good customer service is rarely found these days.I'm sorry Teena.It's all so frustrating when it's a med you depend on & the 90 day supply saves much needed cash.

  4. #4
    It is a double whammy when you go through the hassle to get things straightened out and then find that they misinformed you. Pharmacies, DMEs, doc offices are full of problems that could be corrected if they had a little sensitivity and the will to do so.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  5. #5
    Senior Member MarkPals's Avatar
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    Hang in there, Teena. dont let the turkeys get you down, hon.
    Veni.Vidi,Velcro...I came, I saw, I stuck around.

    Vidi, Vici, et Veni, et Veni, et Veni...

  6. #6
    Super Moderator Sue Pendleton's Avatar
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    Ditto on Ben and Jerry's.

    And make sure when you see your doctor that he puts in your file that your meds MUST be as written including brand name and duration-90 days. It will come up then on your records page on his computer when the pharmacy calls for renewels.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

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