Wednesday, August 16, 2006

Swinging From The Branches Of A Phone Tree...

     "Press 1 if you'd like to remain on hold for another 15 minutes...Press 2 if you'd like to be transferred to the janitor's closet...Press 3 if you'd like to speak to someone dumber than you...Press 4 so we can automatically lose your call in our phone tree system, causing you to repeatedly redial, and eventually giving up your cause all together."

     Yesterday, I spent nearly TWO hours dangling from the branches of my insurance company's phonetree.  It wasn't pretty...I lost my patience...there was eventual gnashing of teeth.

     It's the TYSABRI saga.  You know the one...the story of having an infusion scheduled last week, only to find out my insurance company had yet to even be contacted, let alone APPROVE the drug.

     On Monday, I called my neurologist's office back (promptly returning a phone call I had received from her nurse on Friday) and the office, once again, wanted to schedule my first Tysabri infusion.  Being the ever-diligent consumer that I am, I inquired about my insurance approval.  After much shuffling of paper and difficult-to-answer questions from me, it was soon discovered I STILL did not have appropriate insurance authorization for infusion.

     I worked briefly in the insurance industry in the 80's as a reviewer, so I'm fully aware of the amount and size of fire required under a reviewer's butt to get them to move.  I told my neuro's office I, as the CONSUMER, would begin the nagging process in an effort to "fan the flames" so to speak.

     Tuesday morning began with my usual foggy-fatigue feeling, but I managed to roll like a log out of bed, stumble to the bathroom, and grab the ever-powerful phone to begin my CONSUMER INVESTIGATION into my Tysabri problem.  I first dialed my prescription drug coverage company...their "hold" music was less than desirable, but I maintained.

     The prescription drug department eventually passed me off to two other departments WITHIN their department and I finally got a very nice youngman who dialed my neuro's office and spoke with the nurse directly while leaving me on a 10 minute hold.  He returned to the line, telling me he had obtained information from my doctor's office directly, and gave me another number to call--"the regional pharmacy that will be handling your medication"--and advised me to call them for benefit information.

     I decided to go ahead and make some more calls to find out exactly what my out-of-pocket expense was going to be for these infusions...after all, money doesn't grow on trees where I live...only phone receivers...and it is important to me to know my costs up front so I can be sure to apply for a second night job if needed to cover the cost of my Multiple Sclerosis medications!!!

     What a mistake THIS turned out to be.  I first called my Mega-Insurance-Conglomerate Company who handles the claims for my Self-Insured Government Employer.  It is obvious I will incur TWO charges for these infusions...the medical cost of the infusion center, IV, nurse, etc. and a separate charge for the TYSABRI...this really didn't seem on the surface to be rocket science or some kind of top secret government cover up.  Ah, but I am learning, Little Grasshopper...

     My medical insurance coverage representative, who I'll call Bitchy Customer Service Rep #1, became immediately confused by my questions and passed me off to Bitchy Customer Rep #2 in the Specialty Pharmacy Coverage Department.  BCR2 passed me back to BCR1 because the Specialty Pharmacy was not going to be handling this particular drug...Biogen Idec (the Mega-Pharmo-Drug Company Maker of TYSABRI) holds the reins and controls over TYSABRI and I would need to speak directly to them, papers would need to be faxed, and THEN "someone" might be able to help me.  I explained my previous conversations and the fact this had already taken place...I requested BCR2 to check my records more closely.  She instead, transferred me back to BCR1.

     BCR1 had now realized I was NOT going to go away easily, so she gave me two other numbers to call, mumbling something about my pharmacy coverage not being available information via my medical coverage...I was nowDEEP in the insurance run around and swinging from branch to branch of the never-ending phone tree.

     I called both of the numbers I had been was an accounting department and the other took me back to the original pharmacy representative I had spoken to well over an hour before my latest call.  I called BCR1 back and demanded to speak to her supervisor...BCR1 Supervisor was even less helpful than seems the "Peter Principle" runs rampant in the insurance industry also.

     I eventually called back to my neurologist's office and spoke with her nurse...the plan NOW is to get back "in touch" with the TOUCH Program at Biogen Idec to see if THEY can resolve this run around process...after all, they want to SELL their drug!  Let the people with more money, power, and time than God work on this process...The drug company.

     My arms are very tired from my phonetree "swinging" of yesterday and I still know nothing more than I did at 9:00AM Tuesday...I've let everyone know there will be NO infusion of TYSABRI until I have been made aware of my out of pocket expense...debilitating disease or not.  I live in Seattle, but I'm no friend of Bill Gates and I doubt neither Biogen Idec or my neurologist's office is going to suddenly "slash prices" just to move inventory...such is life...



mdmhvonpa said...

Now if you move to Canada, all this would be done for you and you would only have to wait 3 years to get on the program!  It's good that you are taking a personal aproach to this ... it would never get done otherwise.  In situations like this (I too worked for Blue Shield of WNY, HMO Love-Fest) you really wish you could get all the dullards into a room and make them hash it out.  With lead pipes and wet noodles.

lglbgl2003 said...

Sounds like the run-around I'm getting too Linda, I'm just glad you finally are going to start yours.  The end to my Kaiser So. Calif. fiasco has no end in sight.  Best wishes always, Lauren (my blog site just up last night: