This past week has been a “doozie”, as we would say in the Midwest. I have been dealing with an insurance company change, and all that entails. I found out, much to my surprise, that it entailed more than I ever imagined.
My frustration turned to anxiety, which in turned sparked fear and frustration. Finally, my “inner dragon” came out, and I solved the problem.
I have a very close friend, who also has RA. She has often mentioned that sometimes we need to unleash our inner dragon. She isn't talking about “Puff, the magic dragon” either. She's talking about the fire-breathing variety of dragon that needs, on occasion, to be summoned to win the day.
My dragon has been sleeping peacefully for years. I saw no need to awaken the lazy fellow; however, this past week proved to be the perfect time for my inner dragon to break out of her slumber.
Let's discuss the Orencia Debacle. Two and a half weeks before I needed my Orencia, I provided my Rheumatologist with my new health care card. I stopped working in September, and so I switched from UHC to BCBS, which is provided through my husband's place of employment.
I also called my new health insurer, BCBS, to make sure Orencia was a covered medication. Customer service assured me it was most definitely covered.
When I called to order my Orencia, I was told that my doctor's office had not provided the necessary paperwork. Oh joy! I called the doctor's office, and they said they had provided the information requested by BCBS. Okay, so who is on first and what is on second?!?
I felt like a ping-pong ball being batted back and forth between my insurance company and the doctor's office. Finally, I called my RD's office and told them I had missed two Orencia injections, and I was not doing well. I asked what they could do to help me.
My RD's nurse put me into contract with a pharmacy representative who called BCBS, and then he called me. He reported that the pharmacist at the insurance company's specialty pharmacy had incorrectly entered my information. He or she neglected to document the fact that I had failed Humira, and that I had been on Orencia for three months.
I called the Specialty Pharmacy back. At first they couldn't even find me in their system. After they found me in their database, they told me the same old story. They had not received a pre-approval form
I hesitated for a moment, and then it happened. I felt the warm, and unmistakable rumblings of my inner dragon as she drew herself up into fire-breathing mode. And so, it happened.
I gave the gentleman on the other end of the line a rundown of what was happening. Then I told him that if I didn't get my Orencia soon, I would not be able to walk, and that I needed someone to straighten this out today. Additionally, I kindly explained I did NOT want to be transferred to someone's voice mail.
The poor guy listened attentively, and then suggested I talk directly to the pharmacy. He transferred the call. The woman who answered the pharmacy phone proceeded to tell me that she had the script, but that the medication needed a pre-approval...again!
I gave her the same story I gave the first guy I talked to. I also added that this problem stemmed form THEIR pharmacist entering my information into their computer base improperly. I explained I had failed Humira, etc, etc, etc.
This woman seemed a bit shell-shocked. She put me on hold for quite some time. When she came back, she asked me where to send the Orencia. Hooray! Someone finally listened to me, and did a little more than just look at the information that automatically popped up on the computer screen.
Don't get me wrong. These people from BCBS were nice people. They just did not go the extra mile until my dragon awoke and snorted some fire their way.
I do have one word to the wise. Try not to singe your eyebrows when you are putting heat on those who apparently need heat to do their jobs properly. You might even want to keep a fire extinguisher handy. Sometimes those awakened dragons have trouble going back to sleep.
Published On: October 30, 2012