18 February 2011

Insurance Run Arounds

I'll start by apologizing... this post is more of a book - so feel free to click off of this blog post now... however - if you enjoy drama in any fashion - well, this blog post just might be right up your alley.

My company, and I love the company I work for, recently switched around some of the insurance coverages we have. We still have the same medical coverage – but the switch has been with the prescription portion of our plan. I’m in a complete nightmare trying to figure out something as simple as a drug co-pay with them. YIKES. I’ve even had to get the company benefits coordinator involved to try to get this straightened out – and still I’m stuck.

It all started when I wanted to find out the copay on a specialty medication (Gilenya – the new MS drug) – and request a refill of another specialty medication. While I was on the phone with them, I figured I might as well get the spelling of my daughters name corrected – so it didn’t cause problems with any possible prescription claims… I couldn’t get anyone in customer service to help me – because I wasn’t authorized… so I emailed our company benefits coordinator:

Who do I contact to get corrections made to our prescription benefit plan? They have my daughters name misspelled – and an old address for me. Each time I try to correct that – I’m told I’m not authorized to correct her name spelling – and with the address, well, that keeps getting changed back to the old one for some reason.

On a side note - I’m sure you’ve heard from others about this change to express scripts for pharmacy coverage… well, while I appreciate the coverage from the company more than even you can imagine, they are such a headache to deal with on the customer end. I spoke with a representative then was placed on hold – for more than 20 minutes yesterday before I gave up. All I was looking for was copayment information & attempting to place a refill order of a specialty scrip. Today it was nearly 30 minutes to get the copayment for one common drug – as the site says to call for nearly all meds I look up.
The response I received was focused solely on getting the name & address corrected – but nothing regarding my issue with the prescription coverage company. So I emailed again (portion follows):

(2/14 @ 11am)
...Also – I don’t know if there is a representative you are able to contact or not – but when speaking with Express Scripts pharmacy customer service department last week, when I was trying to confirm a specialty drugs coverage & my copayment, I was told that I would need to speak with my insurance company to find out that information. They were taken aback & disagreed when I told them they were my prescription coverage company! They actually told me I would need to speak with ‘Wilbur Ellis’ to find out what my coverage was. I had to correct them again & say that Wilbur Ellis is my employer – not my insurance company. Yikes. I still don’t have confidence that I have accurate information – but I have no other numbers/contacts to use. And – I’m still unable to get someone to help me get a refill on a prescription. Hopefully my lunchtime calls today will be more productive.

The response this time was a little more focused – and asked if I had any luck. I hadn’t.

(2/14 @ 3pm)
Thanks for getting back to me. I did not have the opportunity to make the call again today – as work duties snuck up on me & I’ve been trying to get a few things cleared off my task list before I start training a new-hire tomorrow morning. I may try to give them a call tonight on my drive home – however, if you can forward my email to your rep, that would be great. I can’t tell you how shocked I was when I was told that I needed to contact Wilbur Ellis to find out whether or not a certain drug was covered & what the copay would be. It’s kind of concerning when your insurance company doesn’t know they are your insurance company… know what I mean?
The response was prompt (as always) – but concerning to me… I was asked for the date/times I called (no problem) – and the medication names I was inquiring about (red flag to me). But I was told she would have our account manager look into it – so I complied… plus, I’ve been pretty public with a lot of this info anyway… here's my email:

(2/15 @ 7am)
I called in to Customer Service on 2/9/2011 – right around 5:45 the first time. I spoke with a CSR, then was placed on hold while they ‘looked up’ information for more than 20 minutes – so I hung up. The CSR only checked back with me one time during that 20 minute hold time (about 5 minutes into it).

The next call was on 2/10 – just before I emailed you.

Unfortunately I got pretty sick last Friday and was down for the count all weekend – not really surfacing until yesterday.

The medications I’m looking for are Avonex and Gilenya.

Thanks again for all your help.
Now – I hear nothing. I get no response. So I email again today:

(2/18 @noon)
I’ve been on the phone again today – more than 5 phone calls & no less than 2 hours – with both Express Scripts & Curascript. No one can even figure out what plan or coverage we have! I’ve never been so frustrated. Who else can I call to try to get some answers? Each time I call, it’s a completely different answer – and I don’t know what to do.
And again
(2/18 @ 12:30)
I’m very sorry for the bombarding of your email box with this issue. When I hit send on the last email, I was still on the phone with express scripts. Once again I was told today that I needed to contact my insurance company, “Wilbur Ellis” to obtain copay information for the specialty medications I was inquiring about. I asked to speak with a supervisor – or someone that would be able to escalate this issue. The supervisor I spoke with told me that Express Scripts is not our prescription insurance carrier – only a in-between/processing desk for their insurance client, Wilbur Ellis – and that their system shows that Wilbur Ellis is my insurance provider. I was completely frustrated at this point & asked for their ‘grievance’ number – in order to try to escalate the issue within their company further. The number they gave me (877-230-0281) is the customer service number to Anthem Blue Cross! When I called, they looked up the account & said their records shows that Express Scripts is my prescription insurance carrier & gave me the number for Express Scripts once again.
I’m stuck in a very ugly loop here & can’t make educated medical decisions for myself at this point. I’m literally at my wits-end. As a Multiple Sclerosis patient, I need to get these answers so I can get back on a treatment plan to battle this disease. I’m continually hitting brick walls here & need some guidance regarding our coverage & who to call for educated & accurate information.

I'm so confused & angry - I have no idea of who to contact - or what to next. In the interim - until this is resolved - I have zero access to medicine. Don't know exactly why I'm sharing something so private - very publically - but I guess its my way of venting.  Here's hoping all is resolved soon & I'll be able to get back on some kind of treatment program.