Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
i'm seriously having trouble with this right now. i've been a fairly organized and responsible adult for the past few years (while i've been on my psychoactive medication). my mother was a customer service rep for a major health insurer for 26 years, most of my life. i know how to navigate the system.
until now.
the rheumy's office says they electronically sent the prescription. the specialty pharmacy has no idea what i'm talking about. the rheumy's office calls it in. the specialty pharma doesn't have it but requires it to be faxed in. the rheumy's office closes for FOUR DAMN DAYS because of a few inches of snow. this morning they said they'd fax it in. i call the specialty pharma and they said it could take up to 72 hours for someone to TAKE IT OFF THE FAX MACHINE.
flabbergasted. i'm calling you and telling you they said they faxed it - get up and walk to the damn fax machine and pick it up and PROCESS IT.
then the rep from the specialty pharma says i probably need prior authorization so it won't matter anyway. but she can't see that part of my benefits so i have to check with someone else.
i'm supposed to take enbrel again the day after tomorrow. i've been fighting this back and forth crap since 12/27.
i called the member services number on my card for pharmacy services and they TRANSFERRED ME TO THE SPECIALTY PHARMA WHO CAN'T HELP ME.
at this point i was ready to gouge my own eyes out. i called the regular member services number. i give her the very short version - i've been going back and forth with the dr and the specialty pharma and i want to see if enbrel requires prior auth. she says i see the rx here, your dr sent it to the wrong place. she put me on hold for a bit and just came back on letting me know that she's going to get the regular pharma and specialty pharma on the call together and have them transfer the rx from the regular place to the specialty pharmacy. but they can't conference more than three lines so i have to drop off and she'll call me back.
um, what? so my rx has been sitting there doing nothing and no one noticed. a script was sent to the regular mail order pharmacy - a script they couldn't handle - and no one thought to call and follow up on it.
i really hope this giovanna calls me back. otherwise i'm going to lose my damn mind. as it is, i'll probably have to skip this week's enbrel dose - which freaks me out because what if that messes everything up? seriously. so my script for enbrel syringes has been sitting there since 12/18/13 and just sat there. no one did anything. even with the five calls to aetna that i've made, no one thought to check with the 'regular' pharma team. i told them every time my doctor electronically transmitted it in front of me on 12/18/13.
anyway. i think i deserve a nap now. of course, the phone will ring as soon as i drop off, i'm sure. damn it.
until now.
the rheumy's office says they electronically sent the prescription. the specialty pharmacy has no idea what i'm talking about. the rheumy's office calls it in. the specialty pharma doesn't have it but requires it to be faxed in. the rheumy's office closes for FOUR DAMN DAYS because of a few inches of snow. this morning they said they'd fax it in. i call the specialty pharma and they said it could take up to 72 hours for someone to TAKE IT OFF THE FAX MACHINE.
flabbergasted. i'm calling you and telling you they said they faxed it - get up and walk to the damn fax machine and pick it up and PROCESS IT.
then the rep from the specialty pharma says i probably need prior authorization so it won't matter anyway. but she can't see that part of my benefits so i have to check with someone else.
i'm supposed to take enbrel again the day after tomorrow. i've been fighting this back and forth crap since 12/27.
i called the member services number on my card for pharmacy services and they TRANSFERRED ME TO THE SPECIALTY PHARMA WHO CAN'T HELP ME.
at this point i was ready to gouge my own eyes out. i called the regular member services number. i give her the very short version - i've been going back and forth with the dr and the specialty pharma and i want to see if enbrel requires prior auth. she says i see the rx here, your dr sent it to the wrong place. she put me on hold for a bit and just came back on letting me know that she's going to get the regular pharma and specialty pharma on the call together and have them transfer the rx from the regular place to the specialty pharmacy. but they can't conference more than three lines so i have to drop off and she'll call me back.
um, what? so my rx has been sitting there doing nothing and no one noticed. a script was sent to the regular mail order pharmacy - a script they couldn't handle - and no one thought to call and follow up on it.
i really hope this giovanna calls me back. otherwise i'm going to lose my damn mind. as it is, i'll probably have to skip this week's enbrel dose - which freaks me out because what if that messes everything up? seriously. so my script for enbrel syringes has been sitting there since 12/18/13 and just sat there. no one did anything. even with the five calls to aetna that i've made, no one thought to check with the 'regular' pharma team. i told them every time my doctor electronically transmitted it in front of me on 12/18/13.
anyway. i think i deserve a nap now. of course, the phone will ring as soon as i drop off, i'm sure. damn it.
did they call?
hope so
Ros
they also got it right - it's the pre-filled syringes. and i even got my own red biohazard sharps container. i plan on buying lots of ridiculous stickers for it.
although looking at the 'bill' that came with it reminded me how lucky i am to have insurance. i posted it on my instagram (@stephgas)
It sounds like the insurance company and specialty pharmacy caused most of the wasted time and energy, but your doctor's office also sounds like a mess. (I manage the care coordination program for a large network of community health centers, so this is on my mind all the time.). I've had a few different insurance companies over the years, each with their own peculiar rules, but the incredible nurses at my rheumy's office have stayed totally on top of it, and the only delays I've had to deal with where when the insurance company was taking their sweet time to authorize my meds. Our crazy patchwork healthcare "system" is way too complex for patients to manage on their own, and a good doctor realizes that caring for you can't stop when you leave the exam room. Someone from your doctor's office dropped the ball a few times for you- if that's a pattern, it might be worth talking to the doctor about next time you're in.
Caren