I have been going through a very frustrating time trying to get a medication through my insurance company. Here is a synopsis: I called the doctor to fax a script in to the new mail order pharmacy at least a month ago. It is a compounded medication, I have been on it for about 8 years, with no problems in coverage. I checked on it a week later: The pharmacy claims they never got the fax, the doctor's office claims they got a receipt that the fax went through.
Next: They got the script, but they need to check on the ingredients. Meanwhile, I can see that I will be running out of the medication, so I start to taper the dosage. I continue to check every few days. Next issue: The insurance company decided they needed prior authorization since it is not on their formulary. I call my doctor's office, they claim they were never contacted about the need for prior authorization. Meanwhile, I have totally run out of the medication.
Fast forward to this weekend: I call the pharmacy, who tell me they are waiting for prior authorization (as if this were a new development). I call the insurance company, and am told that they denied the prior authorization yesterday, and I need to contact my doctor about switching to a different medication. I am having symptoms now of being without this medication, so I double up on a different medication who's function is related to this medication. (I always tell my patient's not to adjust the dosages of their meds on their own- to always consult their doctor- do as I say, not as I do.) Of course, it was Saturday afternoon, and my doctor's office was closed until today (Monday).
The topic of this blog could be the frustration of dealing with inept systems, the confusion of trying to figure out when to call each of the various parties involved in a situation (in this case, the insurance company, the pharmacy and the doctor's office), the anger of being at the mercy of organizations whose primary objectives are counter to my own (in this case, I need my medication, they are concerned with controlling costs and getting paid). My focus is not any of those topics, though I did get some satisfaction telling my story. Instead, I want to focus on keeping your cool in phone calls like these.
Each phone call I made during this process (there were at least 15) got me more and more frustrated. I needed my medication, and despite my best efforts, I was not able to get it. My biggest pet peeve is other people wasting my time or other resources for me.
I tend to be a very rational person. There were several times I wanted to snap at people I was dealing with, to ask them what kind of idiots work for their company, to demand that they send me my medication immediately, OR ELSE!!!! But what good would it do me? It would not get me my medication any faster. Most often, the person I was talking to was not the person who was responsible for the actions of their company, it would not be fair to them for me to let loose on them. In fact, in most cases, they did their best to track down answers for me. I did at times ask to talk to someone else in the company, as seemed beneficial, but in most cases, once I got all my questions answered, I thanked the person and hung up.
I think I handled this situation the best way I could. Blaming does not solve any problems, it just muddies the waters and makes it more difficult to get anything resolved. I have little control of this situation, but I can control my responses. I chose to stay calm, to accept that I can no longer get this medication. I could appeal the denial, but I have decided not to. I am still frustrated by this, but this is just one of those things life throws at us from time to time. My plan now is to take this as an opportunity to meet with my doctor, to review all my medications and see what changes might benefit me. This will delay my getting this situation resolved by a few more days, but in the end, I hope to come out better than before.