My morning began with a scare, followed by an unnerving wake up call. After a two week-long wait, I still hadn't received my mail order delivery of insulin. My prescription for insulin, a drug I have to take every day, the very drug upon which my life depends on, sat unnoticed at my mail order pharmacy for two weeks -- before promptly getting cancelled.
Three things this experience has taught me
1) You should closely monitor any medicine you order from a direct-mail pharmacy.
2) You cannot assume that any medicine you consume now will be covered by your health insurance company in the near future.
3) For every person on the other end of the phone who don't seem to care about your medicine order, there are some who do.
June 7th, 10:30 AM: Just a week ago I had received a robo-call informing me that my order was being processed and readied for shipment. So where was it? Confused, I put a call in to my pharmacy.
After much confusion, a phone rep informed me (with all the concern of a baked potato) that the computer screen showed my prescription was awaiting "Prior Authorization" from my doctor. Prior authorization is a form doctors must fill out when a patient's drug isn't listed on the health insurance company's list of covered medicines for that year. The list of approved drugs changes yearly, regardless of if the patient has been successfully consuming something for years. The system had been waiting for it since May 26th, when a call was made to my doctor's office inquiring about the prescription. Someone had yet to call back.
I immediately put in a call to my doctor's office to inform them of the pending request for the authorization form. The secretary told me a temp (who had since left the post) had sent in the original script, and no one knew it needed authorization. She left to get the paperwork.
I call my mail order pharmacy back and immediately demanded to speak to a manager. Disappointed, angry, frustrated and hurt, I asked "Why did no one call me to alert me of this hold up? I've been waiting two weeks for a drug, I could die without!" He apologized, offering few answers and little help. He simply suggested that I should have my doctor restart the authorization process.
Wanting to make sense of this, and hoping to feel somewhat acknowledged in the process, I called my health insurance company. "How do these things happen?" I implored Sherry, my phone rep. Patiently, she explained the need for prior authorization and how drugs get covered and uncovered every year. It's clearly all about the money, I reasoned. She could spare me the poorly crafted excuses.
Frustrated, I implored: "I have Type 1 diabetes, I can't live without insulin. I got a call last week informing me of the shipment, it's been two weeks and nothing's been done. How is this possible?" Sherry listened patiently and in a surprising twist of fate quietly informed me that she too had diabetes -- she understood, she cared. Apologizing for the company's mistakes, Sherry vowed to help me, and immediately got to work by sending a prior authorization form to my doctor, even calling to ensure it was properly processed. By the time we hung up the phone I felt not only calmer, but pleasantly amused: I had made a temporary new friend.
At 8:45 the following morning, Sherry called to inform me that the authorization had gone through. She also cleared it so I could get a 30-day supply of insulin from my local pharmacy, as I awaited the mail order script. "I know your doctor's office opens at 10:30," she continued, "and I know you don't want to bother them again, but if they fax a script for a month's supply of insulin to your local pharmacy, I'll make sure it doesn't interfere with getting your 90-day mail order supply."
Problem solved, and with Sherry on my side, I began to wonder why the problem had even occurred in the first place? Why had the mail order pharmacy not taken notice when two days had gone by and my doctor hadn't done anything? A week had gone by and they still hadn't heard from my doctor -- why hadn't anyone called me? How could a doctor's office not have followed through on an authorization processed two weeks ago? Why were people so uninterested?
All these things point to the typical failures of big businesses, not least of which health care companies. Because not developing a culture where employees take pride and ownership in what they do, doesn't allow them the authority to make wrong things right.
Was Sherry's kind gesture merely the product of two diabetics bonding, or the tale of a compassionate individual looking after another? I can't say, but either scenario kind of sounds like health care insurance to me.
P.S. Sherry called me back two hours later that morning to tell me that since my mail order pharmacy hadn’t gotten the prior authorization form in time they cancelled my prescription!
In full dislosure I did not use the names of my direct mail pharmacy and health insurance provider because I have not asked these companies to comment.
Riva is the author of "50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It" and "The ABC's Of Loving Yourself With Diabetes." Visit her web site Diabetes Stories.com.
Follow Riva Greenberg on Twitter: www.twitter.com/diabetesmyths
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To the “three things this experience has taught me” you should consider a fourth: Get all your maintenance medications filled at a local, independent pharmacy. Frankly, the choice of what pharmacy to use should have rested with you – the patient – from the beginning.
Too many patients with chronic conditions are held “captive” at mail order pharmacies that are owned by large corporations known as pharmacy benefit managers (PBMs). No matter how poor the service, patients can’t leave without permission from their health plans.
In contrast, 43,000 Consumer Reports readers gave independent pharmacies the highest satisfaction rates based on personal service, knowledge and speed in filling prescriptions. Consumer Reports readers also found independents competitive on price. In store face-to-face consultations are critical to effective patient care.
As a result, I track my orders through every stage. They still get hung up somewhere pretty routinely, but I have fewer surprises now.
However, I still get irritated when I speak with a "Senior Customer Care Advocate" because their initial words SOUND as though they want to help me, but the end result is "we can't help you until your order is EXACTLY as we want it!" While a portion of this attitude is due to regulation, a larger part is the mail order company trying to save money.