Wednesday, January 11, 2012

More Nexium Battles

Our insurance policy changed at the beginning of the year - not a big deal in the scheme of things, but we knew there would be a few snafus, particularly with so many providers and a medication that requires pre-authorization.

To head off problems with the little guy's medications, I called in his Nexium prescription early. Unfortunately, it was too early, so I had to wait to call it in. I tried again a week later, and it was still "too early." At this point, we only had 6 packets of Nexium left (3 days' worth), so I became a little concerned.

I called the next day and Rite Aid miraculously had Nolan's prescription in-house. I figured it was the result of some system error on their end, but at least his medication was available for pick-up. The pharmacy technician rang up the medication packets, and the total came to $900.

I looked at her and said, "Um. No."

She looked at the documentation stapled to the medication and it said, "individual not covered on plan."

I handed her our insurance card and said, "He's covered. We've used this card several times over the past few weeks and he is listed as a dependent."

Rite Aid had me wait for about 40 minutes as they called the insurance company. Our insurance company told Rite Aid they were too busy to take the call. Rite Aid gave up.

Which meant, of course, that my child didn't have the medication he needed.

I called Dennis at work and he looked at our insurance information online - Nolan was most certainly listed. Of course, our insurance company is having a huge battle with something known as competence: the "start date" listed on our cards was in error (the cards stated 02/01/12 as the effective date, when the real effective date was 01/01/12). The insurance company also had Matthew's name written down as "Motther." I suspect they have outsourced some of their labor. Still, the problem wasn't on the insurance company's end - it was on Rite Aid's.

In any case, I finally managed to get 3 packets of medication from Rite Aid, enough to cover Nolan for one more day.

I called this morning to see if they had sorted everything out, and the pharmacy tech said,

"We don't handle insurance issues. You have to call your insurance company."

I took a deep breath. It was a good thing I was at home and on the phone, or I would have started screaming. Mentally, I thought: "You imbecile! It is your problem, not the insurance company's! I can't fix your system, which is obviously malfunctioning!" Since this wasn't very nice, I didn't say it out loud.

I managed to say, "Talk to the pharmacist. See where the medication is. Then we might not have a problem, OK?"

She checked with the pharmacist and the medication is ready, all for the normal Co-Pay. They had obviously fixed their "system error" that was causing Nolan to appear as if he wasn't covered by insurance.

While we're stuck with our insurance companies and the battles that entails, we are certainly NOT stuck with a particular pharmacy. As soon as I feel the energy level, I'm switching to a different one. We certainly don't need added hassles to the regular difficulties in life!

At least Nolan will get his medication tonight. Sheesh.


Kyla said...

So frustrating! If we had had another problem with K's Augmentin this last time it was filled, I'd have switched pharmacies, too! Luckily they finally seem to have worked it out...for the moment at least!

dlefler said...

We've never had problems with Rite Aid before, but goodness gracious! Delaying his medication and then claiming he's not covered (when we have the card and we had filled other things prior to this). SO frustrating. I'm actually thinking of finding a 24 hour pharmacy, just in case - our local Rite Aid isn't 24 hour...

Herding Grasshoppers said...

Oh my gosh, you can see how people go postal!!!

Hang in there, friend,


dlefler said...

And to top it off, I went to the grocery store right after being denied his medication. I forgot it was "Senior Tuesday." Goodness gracious -there were 90 year old ladies EVERYWHERE! Took me 40 minutes to get four things. By the time I got home, I was ready for some sort of a vacation, lol!

Julia said...

While I don't envy Jess and Jeremy (at Connor's Song) the trials of being separated while he's on active duty, you gotta like how the army takes care of kids with complicated medical needs. As far as I can tell, the approach there has always been, "Okay, what does this kid need, and who can best provide it?" By contrast, it seems like every other encounter between you and the medical establishment involves another frustrating insurance battle. Such a waste of time and energy. Anyway, congrats on pulling on the Mom Gloves and getting the job done.