Thursday, February 23, 2012

"Who's On First" at the Insurance Company?

The bottom of this post has the 4 pages of the timeline mentioned in yesterday's entry. For the sake of brevity, I am posting the highlight of the timeline seperately.

Setting the scene: Andy was discharged from the hospital 5 days earlier. I had been attempting to get his antibiotics filled at the local pharmacy, but the insurance was denying payment. The medications were over $400.00, and after all the out-of-pocket expenses I had already covered, I didn't have the money to purchase the medicine. This story actually is hysterical in a macabre sort of way. At the time, however, I wasn't laughing, I was sobbing and pulling my hair out!!! Read on...


Spent entire day on telephone attempting to untangle this mess. I spoke to Kim 188-446-ext 3819 (case manager). She says she does not have anything to do with pharmacy claims, she told me to call Health Risk Management, where I spoke to Lisa at 1-800-255-5541.

She told me to call Express Scripts at 1-800-234-4879, where I was told to call the Cobra Connection at 1-800-733-9110, where they told me to call the eligibility department at 1-800-357-9597, where they told me I needed to call Express Scripts (again) where I spoke to Samantha, who told me she didn’t know how to help me, but transferred me to ext. 59105 where I spoke to Rosie at the Michigan Call Center.

Rosie finally was able to find record of my payment to Cobra, and told me the reason why the prescriptions were being denied was because the ID# was now supposed to be my husband’s Social Security # rather than mine. I had not been informed of this before. (In fact, the letter I had received from Cobra had said that I should continue to use my previous ID cards!)

I returned to pharmacy, instructed the pharmacist to use my spouse’s SS#. Insurance was still denied. I ended up obtaining the prescriptions without the help of the EPO."


I didn’t mention in my letter to Nancy exactly how I obtained the medicine because I wanted to protect the pharmacist… he had been working with me on this since Andy had been released from the hospital 6 days earlier. He took pity on me because by this time I was bawling my eyes out and Andy desperately needed the antibiotics… so that dear pharmacist gave me the antibiotics at my former co-pay rate and said, “This is ridiculous. They can straighten this out after your husband gets started on his medicine.”

If you want more comedy, here is the rest of this particular saga. Or skip it, that's okay, it's pretty much just more from the same circus. Have I mentioned how much I hate insurance companies???

Click on each page to enlarge.

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