A Blog detailing the insanity of my medical practice and the stupidity of everyday life.
Wednesday, December 4, 2013
Paging Dr. Yossarian
Yesterday I received this fax from a pharmacy company. As best I understand it, they don't authorize the drug involved... So to get it covered I need to call...
Went to a Medicare supplement sales session yesterday. She had a hard time wording: "We don't cover a lot of stuff, but you can always appeal a denial." Do they always approve an appeal? "Ummmm...no."
I'm thinking of making a collage with all the medicare/medicaid denial letters my office receives...maybe copy them on brightly colored paper to brighten things up. And they all come with pages and pages of appeal instructions. The last instruction should read: Don't bother!
Yes, par for the course with optum Rx. They tried to force my daughter to have growth hormone stimulation testing on a next to nonexistent pituitary verified with imaging... You know, to make sure she REALLY doesn't produce her own, in spite of years of clinical documentation to that effect. 5 months, 2 appeals and an escalation later we got approved. It was bloody.
Your prescription could have been an error, or an extravagance, or just something you doodled while talking to the patient. So, they just deny the prescription.
When you call them, they can tell that you exist, that you really care, and aren't drunk (at least not all the time) because you have dialed their number correctly and speak without a slur.
They think a while, then regretfully deny the prescription. Cost control, you know.
Finally, you can send a nice card (get well is good) and a small gift expressing a heartfelt sentiment. Then, they will probably approve the meds.
A greeting card. When you really need to show that you care.
basically the insurance company is f***king with you. The hoops you have to go through to get the medication approved by insurances.... from my personal experience, I went through 5 transfer calls and at the end, the person threatened me that she will disconnect because I was the intern...
Oh criminy. They are such morons. I have reason to know because I have the great misfortune to have them as my Rx insurers.
I am in Europe for 2-3 months at a time twice a year and what I have to go through to get my meds is unbelievable b/c their policy is no more than one "vacation override" per year.
When you see a skinny blond screaming into her cellphone at the pharmacy pickup window, please feel free to introduce yourself to me.
Brave new world
ReplyDeletePretty sums up everything wrong with American health care.
ReplyDeleteI didn't even realize that Comcast was in the health care business.
ReplyDeleteWell isn't that ... special. And Optum's my dad's Rx provider.
ReplyDeleteWent to a Medicare supplement sales session yesterday. She had a hard time wording: "We don't cover a lot of stuff, but you can always appeal a denial." Do they always approve an appeal? "Ummmm...no."
ReplyDeleteI'm thinking of making a collage with all the medicare/medicaid denial letters my office receives...maybe copy them on brightly colored paper to brighten things up. And they all come with pages and pages of appeal instructions. The last instruction should read: Don't bother!
Delete"There, there," Yossarian said, because he did not know what else to say. "There, there."
ReplyDeleteAnd, around, and round, and round she goes, and where she stops, nobody knows.
ReplyDeleteWelcome to the f-ing fantastic world of pharmacy.
ReplyDeleteGreat! that will be our rx insurance this coming year. So far all I can figure out is it's costing us $200 more a month and doesn't cover ANYTHING!
ReplyDeleteYes, par for the course with optum Rx. They tried to force my daughter to have growth hormone stimulation testing on a next to nonexistent pituitary verified with imaging... You know, to make sure she REALLY doesn't produce her own, in spite of years of clinical documentation to that effect. 5 months, 2 appeals and an escalation later we got approved. It was bloody.
ReplyDeleteYour prescription could have been an error, or an extravagance, or just something you doodled while talking to the patient. So, they just deny the prescription.
ReplyDeleteWhen you call them, they can tell that you exist, that you really care, and aren't drunk (at least not all the time) because you have dialed their number correctly and speak without a slur.
They think a while, then regretfully deny the prescription. Cost control, you know.
Finally, you can send a nice card (get well is good) and a small gift expressing a heartfelt sentiment. Then, they will probably approve the meds.
A greeting card. When you really need to show that you care.
basically the insurance company is f***king with you. The hoops you have to go through to get the medication approved by insurances.... from my personal experience, I went through 5 transfer calls and at the end, the person threatened me that she will disconnect because I was the intern...
ReplyDeleteOh criminy. They are such morons. I have reason to know because I have the great misfortune to have them as my Rx insurers.
ReplyDeleteI am in Europe for 2-3 months at a time twice a year and what I have to go through to get my meds is unbelievable b/c their policy is no more than one "vacation override" per year.
When you see a skinny blond screaming into her cellphone at the pharmacy pickup window, please feel free to introduce yourself to me.