Saturday, May 23, 2009

A family vs. health/prescription Company

So, many of you know that we have been seeking medical treatment for our youngest for the stomach problems the child is complaining about. We followed all proper protocol for the current health insurance and Prescription Company that we pay for through my DH work.
We went to the specialist a week ago. The specialist gave us samples to try first with a prescription for the said medicine to try. Well, before we ran out of the samples we turned in the prescription to the pharmacy. We get a call from the pharmacy saying that it was not “pre-approved” by our prescription insurance but the pharmacy has started the process for pre-approval. Could we the parents call the doctor’s office to ensure that they contact the insurance company, for a resolution that is speedy (love Mr. Roger’s Neighborhood terms sometimes).
So, we called the doctor’s office. They had already submitted the form to the insurance company. We might want to call the insurance company to just give them the urgency to make a speedy resolution.

This is the conversation that followed.
Code for conversation: p.c (prescription company), and us (family members).
Us: yes we are calling to ensure that our child can have her medicine covered.
PC: The pre-approval has been denied because the doctor didn’t follow our protocols to have approval for this medicine.
US: Say what?
Pc: you didn’t try these said medicines that our pharmacist has said you need to try. They are capsules and a suspense liquid that can’t be flavored.

US: Excuse, one this is a five year old that can’t swallow capsules and the suspense liquid must be flavored because she won’t swallow it if it takes awful.
PC: Denied until you try these others.

Us: you understand that by taking this route it will bet torturing my child with medicine that has been already used and doesn’t work. Also the child will then have an unnecessary scope procedure because the said child is on the wrong medicine.
PC: You are still denied until then.

Us: You know what you are asking is considered child abuse and abuse of your own protocol with the health insurance company.
PC: You are still denied.

Us: are you even human, man or woman?
Pc: we are human just follow the protocol.

Us: you know that the child will choke on said capsules and throw up said medicine.
PC: You are still denied.
US: you know that have just caused your company a lawsuit, right? One in which, we will own everyone one you’re stupid backsides and the word protocol will no longer be allowed.
PC: Protocol ,Protocol.

At that point, my DH walks into the room takes over the conversation. He then instructed me to get the doctor’s office on the phone. Unfortunately, it only went downhill from there. They first couldn’t find my child in their new system. Then they were going to send me to a clinic over an hour away from me for more samples to keep this child very happy and pain free. Then they realized that one closer had samples on hand. Phew, no fighting traffic!

In the mean time, DH and his insurance coordinator had a conversation about how to get the said medicine covered. In the mean time my cell phone missed several calls from the doctor’s office which I will return Tuesday to ensure that they file an exception form to the protocol because it’s a pediatric cause not an adult case. Not to mention the huge improvement in eating, sleeping, and oh overall behavior of the child.

1 comment:

Kate said...

We've gone through that crap too. We pay them a mint and when we need their help...It is unreal how cruel these companies are willing to be to save a few bucks. I bet a really good class action suit might change this...

so sorry your family is going through such a trying time.