Friday, February 3, 2012

The Health Care Games
People Play:
What Should I Do?

It's been a long week.  I attended a plethora of doctors' appointments this week so could be ready to start Hepatitis C treatment.  My week included painful procedures Monday and Tuesday and ending with frustration on Thursday when I learned the new neurologist I saw wasn't a good fit for my needs.  Right now I am tired, grumpy and beyond annoyed.

So take what I am about to say with a grain of salt.  Oh, and I have purposely not named names to shield myself from any venting fallout.

A Really Slow Process

One of the things that is really bugging me right now is how long it is taking to get my Hepatitis C treatment drugs.  I saw my hepatologist on January 10th and I learned from the support staff (see below) that he didn't write the prescriptions until January 20th.  Then it took my call on January 24th to finally get the prescriptions faxed to the pharmacy. 

Unbeknownst to me, my primary insurance information got deleted from the hospital computer system, so my prescriptions got sent to a private specialty pharmacy that bills Medicare, my secondary insurance.  I'm not sure how that happened, since I verify that information every single time I come in to see my doctor.  

Getting the Ball Rolling

As I mentioned above, I called two week after seeing my doctor since no one had contacted me like the doctor said they would.  During my first conversation with support staff, I got a "song and dance" about how it takes 2 to 3 weeks to get things going.  It was after that lecture that we got to the business of checking on the status of my prescriptions and discovered the deletion of my primary insurance information.  I then went on to inform the staff of the details of my prescription benefit coverage, which is a separate entity from my primary health insurance.

I thought we ended the discussion with the staff person saying my prescriptions would be re-routed to my prescription insurance's specialty pharmacy.

Confusion Ensues

A day or two later I got a call from the private specialty pharmacy saying that they couldn't find my Medicare drug coverage.  So I called them back telling them that Medicare wasn't my drug coverage and that I had private prescription insurance.  I told them the prescriptions were sent to them in error and were being re-routed to my prescription insurance's specialty pharmacy.  Then this past Tuesday, the private specialty pharmacy called me again wanting my private prescription insurance information.  I called them back once again explaining that the prescriptions were sent to them in error and asking them to please forward them to my prescription insurance's specialty pharmacy.

I then called the support staff at my doctor's office since I was getting the distinct feeling that things were not happening the way they were supposed to be.

Doing Things Their Way

Sure enough, the staff did not send my prescriptions to my prescription insurance's specialty pharmacy.  No, I was told that working with my prescription insurance was a "nightmare" and they would rather use this private specialty pharmacy than deal with my prescription insurance directly.  When I told them I called my prescription insurance and was told the Hepatitis C medications would only be covered if they came from their specialty pharmacy, I was told that I was given incorrect information.

Yeah, O.K., whatever.  I'm not going to argue.  I figured that their private specialty pharmacy would be told the same thing when they called my prescription insurance.  No sense in belaboring the point when it was clear the staff was persistent in doing things their way and perceived my phone calls as "getting more involved than I needed to be." 

Prescriptions from the Barrio?

I decided I wanted to learn more about this private specialty pharmacy the staff is so in love with.  So I Googled the number they called me from and the first link was to their website--which was down.  So I went back to Google to search the other name the staff used for the pharmacy and this is what I found on Google maps: 

My prescriptions are coming from "Rx Farmacia"?
Where is the front door?
And is that crime scene tape on the street in front of the pharmacy? 
Is it just me, or does it seem ________ (insert an adjective here) that a big university medical center rated "Best in the West" is sending my prescriptions for Hepatitis C treatment here?  And O.K., so I shouldn't judge a book by it's cover, but I certainly find it odd that this book's title is in Spanish.

What Should I Do?

In all seriousness, I feel incredibly uncomfortable with my medications coming from here.  I mean, I have seen other private specialty pharmacies and none of them looked like this.  I am praying the my prescription insurance gave me the right information and will deny coverage because I admit the look of this pharmacy conveys the messages "counterfeit medications," "money laundering" and "fly by night."

I mean, I hate to admit this, but based on appearances I trust my prescription insurance's specialty pharmacy way more than this place.  Plus I did some more research and discovered that my prescription insurance's specialty pharmacy can have my medications delivered to my local chain pharmacy location.  The pharmacy pictured above is in East Los Angeles, which is nowhere near where I live or could get to on my own.  So they have to ship my medications and I have to wait around to receive them so I can get them into the refrigerator ASAP.

This all begs the question: if you were in my shoes, what in the world would you do???

I can't wait to read your answers...

ADDENDUM: 6:01 am--After I posted this, I called my prescription insurance's specialty pharmacy and I am happy to report that they received my prescriptions for Hepatitis C treatment.  Not sure if they came from the private specialty pharmacy or the doctor's office; either way I don't care!  I am so pleased with this outcome!  I am now eagerly awaiting a call from Brittany who will facilitate the process.  Because I am worried about the "nightmare" comment (see above), the first thing I am going to do is ask Brittany to call me every time they need something from my doctor's office so I can keep in top of them.

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Migrainista said...

Yikes! I would NOT want any of my prescriptions coming from a place like this.

Lorna said...

Hi, I am glad prescription has finally come through.
I would definitely be worried about super chemist, it looks a bit like a warehouse or a front for something dubious!
Some docotrs receptionists need to remember that the patient comes first and that she should be accomodated for. After all the receptionists wouldn't have a job if not for us chronically ill patients.

lorna x

Anonymous said...

Selena, What I went through with doctors during my treatment (44 weeks out of the desired 48)is something I haven't shared on my blog because I don't want to scare people. If I hadn't had my husband and son to help, I don't know what would have happened to me. After about three months, I was too sick to give myself shots and too sick to manage all my specialists. My heptologist has a PA that handles his hep c patients and she didn't really do much to manage my treatment either. I should have hand my internist do it. My husband finally put his foot down and decided that he was the one "driving the bus", as he put it. I hate to say it but sometimes, you have to be tough and make them do what they are supposed to. I also, hate to say this too but I think many people in health care are prejudice toward people with hep c. I was in such misery with that fungal infection and it was really hard to even get anyone to take an interest. So...go in fighting and if you can, be ready to have someone else step in and take charge if you get too sick. Treatment has changed since I went through it and I'm hoping that the shortened length of treatment due to the new medication, will make all the difference for you. I'm rooting for you!

Pam, www.boomerback-beat.com

Chris Dean said...

Holy cow, woman! What a week! I'm glad the pharmacy issue was resolved. You handled it so much better than I would have. I think I would have called my Insurance Carrier and sicked them on the Doc. Actually, I've dont that before...the Insurance threatened to withhold payment pending compliance...good luck!

Shannon said...

I would have lost my mind and told them exactly what I thought of their "system". I would have become the "customer from hell" and demanded they do it the way it was supposed to be done or they'd hear more about it. I would have been so livid Selena! There is nothing worse (in my mind) than incompetent professionals. There is NO reason for it other than sheer laziness and utter disregard for the patient (in this case).

I would have called the insurer and had an explanation faxed to the doctor's office or wherever that clusterfeck originated. Perhaps I would have demanded a phone call from the doctor (or pharmacist) to explain to me WHY his staff was so ineffective. There is NO reason your medication should have taken that long to get to you. The doctor alone - WTF? taking DAYS to write the prescription? I have to go to my doc's office for any prescription at all, and I leave with it in my hands every single time. I sure feel grateful for that! Now knowing it's seemingly not typical for everyone.

I am so grateful for my pharmacist. I can't imagine how much he must have to deal with similar bullcrap.