They say it’s not what you know, but who you know. But sometimes it’s more about knowing how to talk the talk.
In moving from Michigan to New York, I wanted to make sure that I had enough medication to get me through moving, transitioning to school, and getting care set up in New York.
I went to the pharmacy and they told me that because my insurance would most likely deny giving me refills since it was too soon to fill (a week early), that I should try and call my insurance company, have them approve it, and then go back to the pharmacy.
So I called the insurance company, and when I explained that I was moving, they told me that there wasn’t really anything that they could do for me.
But they told me that if I asked for a vacation override, they would approve it.
I guess my vacation in Hawaii is more acceptable than relocating.
Okay, so maybe I’m just jealous of people who need extra meds because they are going on vacation to Hawaii. But moving is a totally legitimate life event.
Anyway, the point is, had I not been told that, I probably would have walked away frustrated, with no meds, and most likely would have run out and had to go without until I could get things figured out in New York.
I don’t advocate lying, but when it is something stupid, like requesting a vacation override for basically any situation in which you will be in a position making it difficult for you to get meds, it’s easier to play the system. And by that, I mean, beat the system at their own game (which is notoriously not patient friendly).
And when insurance companies share trade secrets, well, that’s just a bonus…that you utilize…
To be clear, my case was completely legitimate. And I told the insurance company that if they didn’t give me meds, even if all they were willing to give me was two weeks worth, were risking the consequences of me having to skip taking my meds because I ran out and had no way of getting more.
My moving situation was very complicated, and I had a genuine concern that running out of my meds was a likely thing.
Ultimately, I got what I needed, and was no worse for the wear.
But had I not known the jargon and insurance speak, I would have been left high and dry. And I can only imagine how many people have complicated situations in which they need meds, and don’t get them because they don’t know how to bargain with the insurance company or the pharmacy.
Knowing the right thing to say is clearly more effective than giving some sob story.
And this is more about health literacy than it is about the pharmacy or the insurance company. It’s about being a savvy patient, who knows how to get what you need and want from the system.
This is not an easy thing, which is only made more difficult when things are said and done on a technicality.
Published On: September 30, 2013