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Dr. Bill's Commentaries

Mangled care strikes again   (July 14, 2008)

You may know it as "managed care" -- but I call it mangled care.

My most recent mangled care horror story begins last month. I made the bad mistake of believing the propaganda that it was cheaper to get my two prescription pills filled by mail-order through a pharmacy benefits manager for three months at a time, rather than by stopping by my local pharmacy for one-month-at-a-time refilling. So I asked my physician to fill out the forms authorizing the scripts to be mailed to me.

Then I waited for my pills. And waited. And watched my supply of the pills dwindle down to a single day's supply. Still no mail-order package. So I tried getting a refill from my local pharmacy. No dice -- their computers were told that I had just refilled 3 months' supply (the mail order!).

I promptly called the mail-order folks, and learned that indeed the 3 months' supply would be mailed out -- a few days hence. And that I could purchase the pills locally for a weeks' supply -- and get reimbursed by them. She even gave me the address for reimbursement and what it should say ("Attention Retail Reimbursement"), and told me to send in the receipts and I'd get my money back.

So I did. I sent the original register receipt. And the prescription info from the two scripts, showing drug name, dose, number of pills, date, my name, etc. And I even sent a cover letter, with my ID number. They had it all. Or so I thought.

They sent it all back. They sent me an unsigned form letter (which didn't have a phone number), highlighted in two different colors (yellow and pink). They also sent me back my script info, the pharmacy receipt, the cover letter, and even the envelope in which I had mailed it all to them. Complete. All. Nothing left in their collection. Hence, they can now claim with a straight face that I had never sent anything. Infuriating.

So, my next problem was to find a phone number for them and find out what happened. The number I found on their website wasn't helpful -- the number there was only for automated inquiries, and didn't allow to talk to humans. Next, I went to my insurance company website, and eventually found a number for Medco where humans actually talk with customers. Or maybe I should say they doubletalk with customers.

The first person I chatted with was a delight: she said I indeed had sent everything I needed the first time. She blamed an error in processing. And offered to have me send the entire package to her, for payment. Or to put me in touch with a supervisor, who could take a fax over the phone to get the process going. Which sounded even better.

Then, the supervisor told me the info from the first person was wrong -- she couldn't (or wouldn't) take a fax. Plus, I had to send the necessary information to the original address, not to the new address. And a pharmacy receipt is different from a cash register receipt. And I'd have to go back to the pharmacy to get the correct forms. And she added something I hadn't heard before: I won't get my money back in full. They'll deduct a co-payment amount.

Whaaaat? I asked why no one else had mentioned a deduction for a co-pay. She really couldn't explain anything, except that those were the rules. I asked her why I should believe what she was saying as compared to what the other folks had said. She said I could talk to a supervisor. But her supervisor wasn't available, and she took my number so the supervisor's supervisor could call me back. It's now four hours later, and no call back yet. Want to bet that I never get a callback?

I am totally convinced that this episode of mangled care was designed to frustrate the consumer into paying for their own health care rather than repeatedly submit information over and over to finally get back reimbursement. I now don't know which address to send the information to, I don't know what to submit, and I don't know whether next time I'll get the same runaround again, or a new one, or perhaps even a reimbursement check.

Come to think of it, when I send in the paperwork next time, I think I'll send them a paper copy of this essay, and the hyperlink so they can read it on-line. Hmmmm. Sounds like a plan!

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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