Saturday, August 21, 2010

Update: Questioning Everything

This is an update to previous posts, which you may want to read first if you haven't had a chance to check them out yet. 1. Fight For Our Health, and 2. In Case of Zombie Apocalypse.

Both involved my order of One Touch Blood Glucose Test Strips, which was more than the initially insurance-approved 102 per month (roughly 3 tests a day) and significantly fewer than the needed 300 per month (for 8-10 tests a day). My Endo's office had to request the higher amount from the insurance company, which happened after a medical assistant obtained after spending 45 minutes on the phone with a pharmacist and supervisor one day. Getting the order delivered to my home, I saw that they did indeed ship the needed nine boxes of strips that insurance payed for. But they also sent nine boxes of Lancets, which insurance decided not to cover at all. Since I hadn't requested or needed the Lancets, I dove into finding out how this all happened.

Inquiring about this by phone, I was told by Medco that my Endo's office had requested the Lancets. So, I phoned my endo's office to investigate that claim. It took several calls over the course of the week, and I finally connected with the needed person after notifying them I'd be filing a claim about the doctor's office with our state insurance commissioner. That didn't go over well, so Mr. Office Manager immediately worked to help me.

He told me there was, in fact, no order for Lancets to Medco. He provided documentation showing every prescription they'd sent to suppliers and pharmacies, and the Lancets from Medco clearly weren't on the list. So, I went back to Medco.

A customer service representative informed me my doctor's office had actually requested these, despite my documented proof showing otherwise. She declined to send me any proof from her end, saying she didn't have "the authorization" to do so Once she agreed, Customer Service Rep said she was only authorized to send that proof by mail, not a more immediate fax because of this "time-sensitive matter." I asked if her supervisor had that authorization, and after hearing a sigh of frustration, was connected with said supervisor. That woman had no answers, but connected me with a pharmacist who apparently was involved in this specific Lancet order.

He was a nice enough guy. After checking the system, informed me that a medical assistant with a specific name I recognized did request the Lancets, by phone. It was not a written prescription, but a phone request. That was recorded, and if I wanted they could have the call pulled, review it, and call me within 24 hours to play it back to me. I've never had that before, so I was curious to play it out.

The following day, I received the call from the pharmacist. He'd reviewed the call, and said the Endo's Office Medical Assistant did in fact authorize the Lancets. I asked to hear that myself. He played it. But, mysteriously, no specific "request" can be heard for the Lancets. At one point, they just start talking about the Lancet types and what's wanted. The Medco rep asks if a certain style of Lancet is OK, and Medical Assistant inquires with someone unknown on her end, then says "That's fine."

I pointed out to Pharmacist Man that it's not clear that Medical Assistant actually requested the Lancets. Possibly, the Medco rep brought it up first following the Blood Test Strip order, just assuming that the order also included the Lancets. Mr. Pharmacy Man agreed, and said it wasn't clear. I noted that it wasn't a big deal, that I didn't want anyone to get in trouble, and that it wasn't going to be an issue to pay the small amount for the Lancets that I actually should use more often than I do.

Pharmacy Man didn't want me to pay for something that I hadn't wanted, simply because of a mix up. He thought it would be fair to give me a credit or refund on my co-pay. I repeated my nonchalance, but again Mr. Pharmacy Man said he wanted to be fair. I didn't care, but said I would object if he felt the need to refund my $73. So, he did.

I now only owe the $25 co-pay for my strips. And I got 9 boxes of Lancets for free, which will likely last a very long time (at least until the Zombie Apocalypse).

All because I didn't take the word of the invoice or the 1st Medco Customer Service Rep, kept pressing my Endo's Office for answers, then grilled the subsequent Medco Folk some more.

The point: Always question what they tell you. Get names, times, keep track of who you talk to and when. Get documentation, not by mail, but immediately. Go to the higher supervisor levels until someone has the appropriate "authorization" to answer your questions. In doing so, maybe there's a chance things will work out the way they should have from the start.

5 comments:

Judi said...

I'm proud of you. You did a good job. You grandma would also be proud, as that's how she always taught me, and I how I tried to teach you. You learned well.

Lisa said...

Talk about diligence! Congrats on your victory!

Genevieve said...

Way to persist until someone pays attention! It should never be that hard, but it can really pay off to keep on calling until you get a reasonable result!

Anyway, I work with Desert Springs Hospital and was wondering if you could email me privately.

Thanks
Genevieve
glawrence621@gmail.com

Kim said...

Way to be persistent! Glad to hear things worked in your favor (as they should have to begin with).

The poor diabetic said...

what really bothers me is the fact that it doesn't necessarily have to be this way. The denial by the CSR was a classic example of why the art of customer service is dead. Way to crack that whip