insurance insanity

Watch an Insurance Company Try to Drive Me Insane, Again

As you may or may not know, Express Scripts and Medco merged last year.  What are Express Scripts and Medco?  They are what’s known as Pharmacy Benefits Management companies (PBMs).  Basically, they are a third party that processes prescription claims.  They are the ones who create the charming prior approval forms that I’m always complaining about.

Anyway, two of the largest companies, Express Scripts and Medco, merged. They made sure to reassure customers that they would continue to “receive the high-quality care you expect.”  Well, my expectations were pretty damn low, and I’m happy to report that the newly merged company has more than met them.

Oh, I hope you enjoy my new Post-It notes that I’ve used to block out identifying information.  They eloquently express my feelings.

This saga started on January 8, when I received a PA form for valacyclovir, an anti-viral medication that is generic.

On January 10, I received a letter from Medco, stating that the PA was not even needed.  Please note, THE PATIENT HAD ALREADY PICKED UP THE MEDICATION ON JANUARY 8, THE SAME DAY I WAS MADE TO FILL OUT THE DAMN FORM IN THE FIRST PLACE.
Then the patient’s pharmacy (CVS) called me asking, “Where the hell is the PA for this patient’s medication?” despite the fact that they HAD ALREADY DISPENSED THE MEDICATION TO HER!
I faxed them the form form back saying that no PA was needed and faxed a copy of the letter to them.  They apparently didn’t really care, because they sent me another request for a PA on February 5.
I faxed them a copy of the letter again.
Then, today, I received another PA from Express Scripts for the medication!  Two months into this saga.  Like a good little soldier, I filled it out again.
After I filled it out today (since I received it today), I got this fax, sent today but dated yesterday.

Apparently, they are unable to approve the medication that they have already approved.  Why not? Because apparently my evil twin withdrew the PA request.  So, Medco tells me it’s not needed, Express scripts tells me it is, and hours of time are wasted.

Read what Express Scripts had to say in their press release about the merger:

“Our merger is exactly what the country needs now,” said George Paz, chairman and chief executive officer, Express Scripts. “It represents the next chapter of our mission to lower costs, drive out waste in healthcare and improve patient health. We remain focused on formulary management, channel management and closing gaps in care, which will allow us to further improve the health of people with chronic and complex medical conditions.

Yup.  Tell me another one.

I can’t wait to see what’s waiting on the fax for me on Monday.

4 thoughts on “Watch an Insurance Company Try to Drive Me Insane, Again”

  1. Oy gevalt! Maybe you should send your redacted collection to someone in authority in the offending company. It couldn't hurt.


  2. I swear, I was trying to get my son's migraine meds filled, and our BCBS/express scripts automatically refused it, saying they needed PA for it.

    When we went to get it, the doctor's office had already sent the PA in, and they still wouldn't pay. They claimed a neuro had to write for it. So off we go to the neuro AGAIN, having just been there, and get HIM to write for it.

    All the while I'm paying 40 a pill for this stuff. out of pocket.

    The Neuro writes it, the pharm tries to fill it and they get a PA demand AGAIN. By this time, something like 7 weeks have gone by since the original attempt to fill.

    Their reason for refusing it this time? It's “experimental”. I was ready to knock heads.

    We eventually got it covered, barely, and they provide 18 pills every 3 months. And even with insurance, it's still $$.

    Completely ridiculous. ~nyb


  3. It wouldn't have been so infuriating if it hadn't become blatantly obvious they were lying to begin with and never intended to cover it. I jumped through their hoop and scheduled another appt with our neuro, got it rewritten, only to be told it was experimental.

    Also ? It went generic in the middle of all this fiasco, and no one bothered to tell me til AFTER I'd shucked out 120 bucks at the pharmacy. *Crazy*


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