I Could Swear They're After Me

[Gaki]

Do you ever feel like the whole world knows you have a social anxiety problem and tries to make you confront it at every given chance? Maybe thats why I've been having so many problems with tech support, pharmacies, and insurance companies. The world is after me.

Second there was Wal Mart messing up EVERY SINGLE PRESCRIPTION I EVER FREAKING GAVE THEM.

And now there's this:

I go to "BVS" Pharmacy because I'm tired of Wal Mart messing around with my prescriptions. All fine and dandy until the pharmacist tells me that the insurance has rejected me. Why? I'm a full-time student and I'm 20 years old. It's my mother's insurance. There's no reason for me to have been rejected. Rejection slip comes back like this (I have a print-out of it), "66 - Patient Age Exceeds Maximum Age VERIFY PATIENT BIRTHDATE"

...w. t. f. So pharmacist calls them and gets pretty damn angry over the phone because he doesn't understand what the hell they think they're doing. He tells me that my Mom should call them and see if they have me recorded as a full time student.

Mom calls them and the guy on the other end tells her he doesn't see a reason why it would be rejected and tells her to tell me to try again. That's what I did today. Wow, surprise, came back the same way. I call Mom, Mom calls them, I stand around looking like an IDIOT in the pharmacy for an HOUR while Mom's on hold and then she tells me to go to the Doctor's office. Here's where it starts to sound like a wild goose chase/scavenger hunt:

I'm supposed to drive to the doctor's office and tell the front desk lady that I need a "prior authorization" and give her this phone number. Then I'll get further instruction (which turned out to be "go home, this'll take a few days.")

I don't really understand all the kinks that happen here. It's a new insurance but it WORKED at the doctor's office when I GOT the brand new prescription. So a new insurance with a new prescription but the insurance worked at the doctor's office...?

I've had to talk to people on the phone and go up to way more counters than I'm comfortable with (I have a social anxiety with talking to people over counters, the taller they are or the higher the sneeze guard, the worse it is. Subway and pharmacies are my worst enemies) and I STILL didn't get anything accomplished.

So I still don't have medication... which could prove disasterous in an embarrassing kind of way...

[blas]

I'm so sorry this is happening to you.

[Gaki]

I'm so sorry this is happening to you.

They say things come in threes so this could be my third thing so hopefully once this is resolved then I'll be done...although this could count as a fourth since my dog died, there was the Dell thing (which has lasted three or so years in any case),Wal Mart's been f-ing up, and now this.

Maybe Dell counts in a previous string of threes.

You're sweet though, I'm so grateful for this site letting me vent all this frustration. I think it keeps me from murder.

[radiocerk]

Doctor's offices don't have the same billing processes as pharmacies, and in fact, may be billing through an entirely different processor than the doctor. A lot of medical insurances don't handle the pharmacy end of things.

In my pharmacy, everything is submitted to the insurance company before the patient picks up the medication. That way we don't have to send anyone a bill later for what the insurance doesn't pay for.

Doctors, as far as I've heard, on the other hand, submit things through a more complicated form system, which has to be reviewed by the insurance company later, which is why they send you a bill in two weeks to a month for whatever procedure they didn't want to cover.

[Gaki]

Doctor's offices don't have the same billing processes as pharmacies, and in fact, may be billing through an entirely different processor than the doctor. A lot of medical insurances don't handle the pharmacy end of things.

In my pharmacy, everything is submitted to the insurance company before the patient picks up the medication. That way we don't have to send anyone a bill later for what the insurance doesn't pay for.

Doctors, as far as I've heard, on the other hand, submit things through a more complicated form system, which has to be reviewed by the insurance company later, which is why they send you a bill in two weeks to a month for whatever procedure they didn't want to cover.

Makes sense...kinda. I'm still miffed by all the complicated bureaucracy. When I told everyone that they told me it would take a few days for a "prior authorization" (whatever the hell that is) they were like, "A few days to make a phone call? Are we in the 1500s?" (my mom AND my sister actually asked that question with the 1500s...hmm, apple really doesn't fall too far from THAT tree...) I just figured it was all the processing.

[Captain Trips]

"Prior authorization" - if the doctor prescribes one drug, but the insurance company says to take another, to get the one the doctor ordered the doctor needs to tell the insurance company that the substitute won't work. It can take a few days to do the friggin' paperwork.

My doctor prescribed Bextra for my carpal tunnel. I went to pick it up and "Here's your Celebrex." I tried it on a free sample, it didn't work, which is why the doctor prescribed the Bextra. Insurance company said "Not until Celebrex is tried and found ineffective - not without prior authorization." So a few days later (after my doing the leg-work) I got my Bextra. No more pain.

Two months later, the FDA pulled Bextra due to suspected cardiac issues. Okay, my doctor prescribed Vioxx. I went to the pharmacy to pick it up, and "Here's your Celebrex." (Didn't we go through this once already?) Yes, "lather, rinse. Repeat." I finally got the Vioxx days later, it worked (not as good as Bextra) until they pulled IT of the market because "it's close to Bextra, and the FDA made us pull that, so we are pulling this now."

Back to pain.

(Fortunately, I live in California, and have found that legal Cannabis works real well on the pain, but is a bit harsh on my lungs.) (We need to have more medical-marijuana states. It has so many positive uses.)

[Gaki]

...wow. My sister actually has violent moodswings on [Brand A] which is what I WANT to be taking so she has to take [Brand B] and initially I was on [Brand B] but decided I wanted to switch to [Brand A].

They keep giving her what I want and me what she wants. We don't even use the same pharmacy and SHE didn't have a problem with it.

I'm beginning to wonder if it wouldn't just be easier to bleed everywhere and then just tell people "that happens sometimes, no I don't need a hospital, I need a better insurance company."

[Misanthropical]

"Prior authorization" - if the doctor prescribes one drug, but the insurance company says to take another, to get the one the doctor ordered the doctor needs to tell the insurance company that the substitute won't work. It can take a few days to do the friggin' paperwork.

My doctor prescribed Bextra for my carpal tunnel. I went to pick it up and "Here's your Celebrex." I tried it on a free sample, it didn't work, which is why the doctor prescribed the Bextra. Insurance company said "Not until Celebrex is tried and found ineffective - not without prior authorization." So a few days later (after my doing the leg-work) I got my Bextra. No more pain.

Two months later, the FDA pulled Bextra due to suspected cardiac issues. Okay, my doctor prescribed Vioxx. I went to the pharmacy to pick it up, and "Here's your Celebrex." (Didn't we go through this once already?) Yes, "lather, rinse. Repeat." I finally got the Vioxx days later, it worked (not as good as Bextra) until they pulled IT of the market because "it's close to Bextra, and the FDA made us pull that, so we are pulling this now."

Back to pain.

(Fortunately, I live in California, and have found that legal Cannabis works real well on the pain, but is a bit harsh on my lungs.) (We need to have more medical-marijuana states. It has so many positive uses.)

I went through the same damn thing! Well, except the legal Cannabis thing. I swear I would find a medication that worked well and it would be pulled. GRRR!

[AccountingDrone]

Two months later, the FDA pulled Bextra due to suspected cardiac issues. Okay, my doctor prescribed Vioxx. I went to the pharmacy to pick it up, and "Here's your Celebrex." (Didn't we go through this once already?) Yes, "lather, rinse. Repeat." I finally got the Vioxx days later, it worked (not as good as Bextra) until they pulled IT of the market because "it's close to Bextra, and the FDA made us pull that, so we are pulling this now."

Back to pain.

(Fortunately, I live in California, and have found that legal Cannabis works real well on the pain, but is a bit harsh on my lungs.) (We need to have more medical-marijuana states. It has so many positive uses.)

Celebrex made my ankles the size of volley balls ... 3 doses. When I went back to the navy hospital for ambulatory clinic and I got in trouble for hobbling in with bare feet. Hello ... it wasn't like I had any shoes that *fit*

All I wanted was freaking ibuprophen. Next thing they gave me was naproxen, which was about as effective as M&Ms. Finally I got ibu. *sigh*

Connecticut just decriminalized small amounts of pot, haven't heard the MMJ part of the decision yet. Effective July 1. I know what I am doing July 1

[MelodiousBubbles]

Geez... Hearing you guys talking about having to be the ones working on the PA stuff makes me happy for my customers that we take care of it.

At my pharmacy, we have a fax form to send the doctor. The doctor then calls the insurance company, who sends us back a fax with a PA number to put in with the insurance claim. No work required by the customer whatsoever.

That's how it should be for EVERY pharmacy, in my opinion. The customers have a difficult enough time understanding their insurance as it is without the added annoyance of running all over God's green Earth trying to get everything straightened out when most people don't even understand what a prior authorization does to begin with.

But that's just my two cents worth... I hope everything with the insurance works out! It usually does, and if they don't have you listed as being enrolled in school, that's usually an easy fix.

[Gaki]

I hope everything with the insurance works out! It usually does, and if they don't have you listed as being enrolled in school, that's usually an easy fix.

It's never easy if it's me. I learned at a very young age that if something important requires someone else to do it--it ain't gonna work. ESPECIALLY if it's connected to ME. It's half of the reason I hate other people. Because if I'm not breathing down their necks, they don't give a damn about what they're doing. VERY FEW people have been an exception to that and they know I appreciate it a whole lot more than people who always get their way do.

[Shalom]

"66 - Patient Age Exceeds Maximum Age VERIFY PATIENT BIRTHDATE"

Use a relationship code of 04 instead of 03.

[wolfie]

"Prior authorization" - if the doctor prescribes one drug, but the insurance company says to take another, to get the one the doctor ordered the doctor needs to tell the insurance company that the substitute won't work. It can take a few days to do the friggin' paperwork.

Does the beancounter at the insurance company have "MD" after his name? If not, by ordering a drug substitution, he's practicing medicine without a license. A bit of jail time (since that's a criminal offense) should cure him.

[Ironclad Alibi]

A few times my mail order insurance has sent me the generic instead of the brand name prescribed by my doctor. However, they always get the doctor's approval first.

[Gaki]

UPDATE: I still don't have my prescription. I went to the doctor's office because the company told me I needed "Prior Approval" which is fine and dandy. Doctor's office calls to say that it was approved. I go in to the pharmacy thinking that it should work and they tell me that it's still rejected. ALL the pharmacists in that pharmacy are in on this situation and they're ALL pissed off at this point which is why I think I like this pharmacy, even though I've never actually GOTTEN a prescription filled at this one, they seem to actually give a crap. Which is weird for me. Anywho, turns out that the company called the doctor and said it was approved and the doctor called me to say it was approved and then somehow, without me knowing, it was denied and then it was cancelled.

Wut. And THEN nobody called me to tell me that it was "taken back." My approval was TAKEN BACK. So I call my mom and she gets pissed, she calls the doctor because everyone's telling us that the ball is in the doctor's office's court and they can't tell her a damn thing because the ball is REALLY in the insurance company's court so the office calls them and they give the office the run around and then my mom calls the company while the doctor's office calls ME and tells me that the company is telling them that my mom has to call the company and update her information which is BS because that's what she tried to do in the FIRST PLACE and NOBODY WOULD LET HER BECAUSE THEY SAID IT WAS FINE AND NOTHING NEEDED TO BE CHANGED.

So all this calling around has led to one thing: Mom is waging WAR against the insurance company, I still don't have my medication and at any second of any day I could be a bloody mess without warning. So I'm literally carrying around an extra set of undies and pants and about a billion tampons and pads. It could be messy...like crime scene in my pants messy.