So how do you eat an elephant?

One bite at a time is the answer to that riddle. And in starting this blog, I’ve been challenged to answer the question “why will people want to read this specific blog ? “   That’s a good question and I’m not sure people will.

Usually it’s when people are in the middle of a healthcare crisis that they even begin to look for help with care, financing, insurance questions….and this is not a blog for use as a crisis intervention.   I’m sharing how I’ve navigated the healthcare system for the past 40 or so years.   Most of the time I’ve had successful outcomes, sometimes I’ve given up..   I’m writing most of this to get it off my chest and because I want to help.  I’ve been witnessing  health care navigation nightmare issues for years.  If it doesn’t resonate with you then you won’t come back, but I’m guessing that a lot of folks are frustrated, even when doing the simplest things related to taking care of themselves and getting healthcare in general. So as I recount this experience from a few weeks back, its not COVID related, as it happened just before the “Pause”, and I really have no answer for this, but I wonder…. has this happened to you?

I called my doctors office to obtain refills for my prescriptions. At the same time I needed to change the pharmacy .   Simple enough, one would think.  Mind you this is all done electronically and the office staff said they would take care of it. A few days later, I went to the pharmacy.  No prescriptions were called in so  I called back to the office as the pharmacy said they could not call the doctor (and that’s a separate issue….a bad corporate policy I suppose…and why do I think that? Because Im a pharmacist and legally I can call a physician for a prescription.)   So I called back my doctors office and they say yes,  it’s been called in.   I go back to the pharmacy and there are no prescriptions. Sigh. This is getting old.   As it turns out, I have a doctors office visit scheduled for later that week.  So I go to have my annual physical and ask for the prescriptions to be written.   I explain to my physician’s office staff that for whatever reason the pharmacy keeps saying they don’t have the prescriptions.  My physician is happy to comply. 

Later that day,  I take the prescriptions to the pharmacy to get filled.  Two of them are processed as normal but one of them, that usually has a nominal co-pay from my insurance is very expensive …almost  $200, which has never been the case before, and I need this for my migraines.   I figure this anomaly is due to my insurance company changing,   making me change pharmacies from ABC to XYZ,  and I will deal with it later.   So I pay for my prescriptions and go home.   I put the receipt on my “to do” pile which takes me about a week or so to plow through.   About 10 days later, I still have not addressed this prescription issue, but my previous pharmacy ABC calls me to let me know that my prescriptions are ready to pick up.  Do I want them?

So now I know what happened.   I tell them no,  just put them on hold for now. Please return them to stock and reverse the insurance claim.   What happened was that the physician’s office staff called/electronically sent a message to the wrong pharmacy.  Even though I was very clear several times which pharmacy should have been called, they still pushed the wrong button and electronically sent the refills to pharmacy ABC who processed them under my insurance for pick up.  That, in effect, blocked my ability to get my migraine medication processed by the insurance company and I was paying full price.   I still don’t know why my other 2 generic prescriptions were able to go through, and quite frankly, for the 1$ difference, I don’t care.   

Now I go back to pharmacy XYZ with my receipt. Thank goodness it’s within the 14 days to get my prescription reprocessed with the insurance and collect my refund.  Im still not sure why pharmacy XYZ wasn’t able to tell me that the prescription was too soon to refill, which is what the reason would have come up on their insurance rejection claim.   I’m not happy with pharmacy XYZ.  Another case of incompetence, or laziness?, one can never tell.    I begin to tell them that the reason that my one prescription was so expensive was because my doctors office called it in to the wrong pharmacy and…. They are not interested.   They went back and re-processed the prescription and this time it went through the insurance and my co-pay was a few dollars.  All this effort because the girls in the physicians office couldn’t figure out the difference between pharmacy ABC & XYZ… Again, incompetence? Or just laziness or just I don’t care.   

Has this ever happened to you? And would you know how to get it fixed?  Sometimes you have to just let the process happen and then go back an figure it out.  Of course, if that means something is serious and irreversible then you have to address it before that happens.   Not always predictable.  Back to the prescriptions, I will say that very soon,  E prescribing which has been mandated by the opium prescription act and CMS will be going into effect on January 1, 2021.  If that were true now,  I would have had no recourse to bring written prescriptions to the pharmacy . I would have been in an eternal loop not sure how that would have ever been solved accept to ask the physician himself to  look at the record, and most times that’s very unlikely to happen.

 My next blog will be about an irreversible situation that was avoided because of diligence.  You will be asking yourself would you be this persistent?