Tuesday, July 28, 2009

My Insurance claim examiners

I found this picture of the employees on the web site of the insurance carrier in charge of my heart medication...scary...the search was prompted when I tried to refill a prescription and hit a snag. For the first time since being "approved" I had to wait while the pharmacist called the number on my card. He waited and waited, only to be told they will receive a faxed approval within 48 hours. That's so nice. So efficient. This was after trying to refill (as I'd done without problems the last six months) my meds approved since my heart stent. I thought the refills were "forever" or when my heart stops, whichever comes first. I'm covered under NRS 617.457 that covers all firemen and cops, listing heart and lung problems as occupational diseases associated with these two lines of work. I don't think of it as a "disease." I was surprisingly calm. After all, it's only cholesterol stuff, not like any life saving medication. The pharmacist gave me two pills to hold me over. Today, after some research that included three phone calls, I reached my claims examiner. Initially, I heard: "Please listen carefully as our menu options have changed (like I'd remember them anyway). If you know your party's extension, you may enter it any time. If this is a life-threatening emergency, hang up and dial 911!! (slap my forehead; if I had a need for cops, firemen or an ambulance, why the heck would I be calling this 800 number?) "To hear this menu in Spanish, press 3. For an alphabetical listing of company directory, press 4." I pressed 4. "Using the key pad on your phone, spell the first and last name of the person you want." I pressed 54727333. (Lisa Reed) "We're sorry, there is no match for your request. Please re-enter." I lost count of the zero's I pushed next and reached the operator. I told her my problem and complained slightly about their inept answering system. I was transferred without as much as a "have a nice day." I heard the phone ring, ring, ring, ring, and ring. "Hello. You've reached Lisa Reed, I'm out of the office or on the other line assisting, blah, blah, blah ..." It was one of those, sugary, over-enthusiastic voices that only magnifies your frustration. I left a message. Not too terse, but the facts none the less, and asked them what their rationale is..... we'll see what happens.
1 hour later UPDATE: Call from Rx, refill denied. Another call to Lisa Reed. (I knew the extension # this time) She denied it due to different Dr name on script. She did it automatically, even though she told me she knew my Doctor, didn't question it, has my cell number, etc, etc. You know, "Deny first, we can always correct it later." Call to Rx..."same script has been approved since April, same Dr." (it was really phys assistant, I need to get the real Dr to write script). Maybe I'll check my blood pressure on that little machine in the corner when I go to Von's next :)

4 comments:

garrynkim said...

Yesh what a run around. You'd think they'd like to prevent you from getting more agitated, but hey, what do they care, you never get to them in person!!

Carol Swift said...

I hate those press one, two three phone call things. You may need high blood pressure meds after all this!

Shayla said...

What an ugly mess. Why do people have to make such simple things so complicated? I guess it could have been worse. Like Lisa Reed not speaking any English.

Joan said...

How frustrating! We all seem to hate those phone systems! Did you know many times you can push the zero, and get a person? Not always; but it does work sometimes.