Monday, December 2, 2013

Insurance!! Arrrrrggghhhh!!

I hope you enjoyed my pirate sound in the title...I'm a little irritated to say the least. I've been on the phone with Anthem for 48 minutes and counting over one single issue of a prescription reimbursement. It's been extremely difficult to not take my rage out on the lady on the phone because I realize none of this is her fault. Here's the scoop..When Kim was first pregnant, she was constantly sick to her stomach. So, he doctor prescribed her a generic form of take every 4 hours..and gave her 20 pills. 20 pills...20. To take every 4 hours for a month. Do some simple math and you'll realize that if you took even just 2 pills every day, that would still only last 10 days. And our insurance company, like many, will only cover prescription refills every 30 days. So, we called the doctor and she prescribed a pill count of 120. But, it needed to have a prior authorization which then went before Anthem's medical review board.

 In the meantime, Kim was still sick. So, Anthem, remember this, ANTHEM themselves, advised us to pay out of pocket for the prescription ($117) to hold us over and if the prescription was approved by the medical review board then we could get reimbursed. So, Mark and Sharon were nice enough to help us out and we got the prescription. More than a month later we received a letter stating that they had approved Kim's prescription that she no longer needed. So, I set out on the adventure of reimbursement. Three, count em', three, phone transfers (full of holds) and 30 minutes later I was taken to the right place: a lady telling me that she would send a reimbursement form. As Kimmie would say, "Well, glory."

I Received the form, filled it out, took it to Rite Aid and had the pharmacy manager print out the appropriate documents and sign the form, and faxed it over...only to receive a response that our claim was denied because, "The claim is for an amount or dosage that exceeds your plan's limits." You don't say??? Of course it is. That's why we needed a prior authorization. Anyways, the lady is talking to her manager about it and we've talked here and there through the holds and despite my frustration, she is being very nice and helpful and giving her best effort. So, I have to be thankful for that. It's just one of those things that makes you want to pull your hair out even though it's not any one person's fault. I'm at 1 hour 6 minutes on the phone now. Here are some pictures of the process along the way.

I looked in to see how Kim was doing and saw she got a little sleepy holding Elise so I snapped a picture

Sammie likes to sit on my lap when I'm at the PC.  Aside from her wicked typing skills, she helps tons by guarding the computer.

Elise got down to get a swig of milk and went back up to her mom.  A minute later and she is chugging and Kim is sleeping :)


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