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Health Insurer: I Want My 8 Hours And 6 Minutes Back

Discussion in 'General Discussion' started by In Love With Medicine, Mar 13, 2020.

  1. In Love With Medicine

    In Love With Medicine Golden Member

    Jan 18, 2020
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    February is a short month. Even this year with leap day. So short. Maybe that is why I am so mad at what Company X did to me.

    My health insurance company stole eight hours and six minutes from me in February. I will never get it back.

    This is my story of trying to get Company X to pay its part of two drugs I take for seizures. Very important drugs. They always paid before. This year we had a problem. They told my pharmacy no.

    I called to ask why. Over and over for so many days, they would transfer me to different people. Each had a different reason.

    Some said they found I had another insurance company. That is true. I am covered under my dad’s insurance plus Company X Medicare because I have a disability. That has always been true. I never tried to hide it. The other company always paid part of the bill. Then Company X paid the rest. Not this year.

    Some said my doctor had to tell them why I need these drugs for seizures. They did—last year. And in January. And again and again in short February.

    Some said my pharmacy was making mistakes. I took the pharmacy a paper showing the right way. The pharmacy said that is how they do it. But they tried again. Company X denied. (From January 26 to February 24, my pharmacy had to try 39 different times to get my drugs for seizures.)

    Every day when I called Company X, they sent me from “customer care” to pharmacy benefits. Then to clinical intake. Then to coordination of benefits. Some days in a different order. Everyone told me something different. Sometimes we fixed a problem. The next day we see it is un-fixed. Still, Company X tells my pharmacy no.

    I told my dad this is like riding a merry-go-round. Get on. Go round. Get off. Same place. So confusing.

    My dad sent in papers so the Company X people can talk to him. They lost the papers. They will not talk to him without the papers.

    Some nice Company X people tried very hard to help me. They tried to explain in ways I could understand. They stayed with me on the merry go round. It did not help. But it felt good that someone cared. Lots of the Company X people seemed confused too.

    Some Company X people did not try to help. One day one of them told me I needed to file an appeal. I needed to tell them I did not agree with their decision that I have two insurance companies. I told her I cannot do that. I do agree with that decision. I do have two insurance companies. It is true. Why would I appeal a decision that is right? She said that is the only way to fix the problem.

    My dad said this is “Kafkaesque.” I said it is dumb. I asked to talk to someone else.

    I do not know how this problem got fixed. I do not know which of my many, many phone calls worked. I do know that on February 20, Company X said it would pay its part for one of my seizure drugs. I made more phone calls. On February 24, it paid for the other one.

    In February, I spent much time on what the Company X people called “a brief hold.” It was not brief. I listened to the happy voices telling me, “medications are important” and “we care about your wellbeing” and “we understand your time is valuable.”

    The happy voices did not sound like the Company X people. They did not sound confused. The happy voices must live in a happy land. Maybe a magic land.

    Maybe the happy voices can give me back my eight hours and six minutes?

    The author is an anonymous patient.


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