Those of you who read my last blog post about our aggravating situation with the drug insurance company will find this note of interest, I think.
Friday morning, Robin called the company again and talked with a woman higher up the chain of command. He confronted her about them NOT following their own clear guidelines in their formulary book about notifying their clients 60 days prior to any change in their formulary and also about NOT providing him with a 60-day supply of his medication on Friday, Oct. 16.
The woman told Robin that his drug was not on their formulary, but Robin insisted that it was. “You’ve already filled my prescription two times this year,” he said, “once in March and once in July.”
“I’m sorry, sir,” she said, “but your drug is not listed in our formulary.”
“I know it’s not on your formulary NOW since you withdrew it. But I do know it was on your formulary earlier this year. I received the drugs at the formulary price in March and July, and I have the receipts right here!” Robin’s voice began to rise a bit now from its calm and controlled tone.
“Sir, what I’m telling you is that your drug is NOT listed in our formulary for 2015.”
While Robin was on the phone, I went to our files, pulled out the 2015 formulary book, and searched the alphabetical index at the back. Guess what? She was right! Robin’s drug was NOT on their 2015 formulary list!!! We had no idea, of course, because we’d been getting the drug with no problems. However, it must have gone off their list at the beginning of the year.
So now we have a new mystery. How did it happen that we were able to get the drug at the formulary discount two different times this year? Apparently, that was their mistake! Also, now we wonder what will happen to our request for “an emergency refill” that Robin’s doctor sent to the company?
Robin still has an appointment with his doctor on Tuesday to explore options for transferring from this drug to another one, and he’ll still have to have enough of his current medication to taper off safely. However, Robin did apologize to the drug insurance company rep he talked with.
What a crazy development this has turned out to be!
A case of the left hand not being informed what the right hand had done?
Nancy
Sounds like it, doesn’t it?
Madelyn, I read this before your apology and wonder how you reached the point of apology. I am still upset about my unresolved medical experience. However, if you and Robin don’t have enough problems of your own, let me share mine.
I was hauled from GSs in an ambulance a couple of months ago. At St. Vincent’s Hospital, the doctor came in, asked my symptoms, thought I had a bladder infection, ordered a urine specimen, wrote a prescription, and left me on the uncomfortable hospital bunk for 4 hours. I was given a powerful antibiotic shot. I think it twisted my usual good disposition. Ha.
During the 4 hours, I became angry, to the point that I wasn’t going to lie there any longer. So angry, it made me stand back and question if this was my normal disposition or was it medication. At any rate, I left the bunk several times, and went across the hall to nurses. Each time I asked if Good Sam’s had been called to come for me. The answer was “Yes, go back and wait. They will be here soon.” The last time, I shouted, demanded–really ugly.
Now, I think I am being repaid for my ugly actions. I received the Medicare and Tricare insurance statements showing what they paid ambulance, hospital and the doctor. $692 for the ambulance one way. Outraged. Last week, I received an invoice from the doctor (I won’t mention his name), asking me to pay $839. Outraged, so it can’t be the medication.
Goodness! That is outrageous! I know ambulance service is expensive– they pay two EMTs who provide first responder care. But it seems to me the ER doctor shouldn’t have charged so much, unless that is the normal fee for seeing any ER patient. He certainly didn’t do all that much. You could have seen a nurse practitioner at one of our community clinics for less, I think, and could have received the same care. And Medicare should have picked up the tab for all of that.
Love you,
Maddie
What a predicament!
Sent via the Samsung GALAXY S® 5, an AT&T 4G LTE smartphone
Right! Crazy, isn’t it?
Ach! Every time I hear about another monstrous incidence of ineptitude and/or unchecked greed in our healthcare system, my blood pressure spikes! So many questions come to mind about the experience with the modified formulary. For example, why is there a formulary; why does the company decide specific medications are not to be covered? Why does a greed-driven organization have the ability to second-guess physicians about what medications patients need?
Those are good questions! I’ll keep you posted on how this all turns out.
Maddie