Friday, March 4, 2011

The Medical Run Around

I only need a new prescription for a medication I have been on for about a year and a half.

Feb 4 - I go to my doctor's office and tell him I need a new prescription. Using the electronic medical record system, he puts it in the computer so it goes directly to the local Walgreens where I get my prescriptions.

On Feb 18, I called my doctors office to ask for the Meloxicam prescription and another one to be filled through mail order. Later in the day I went to the pharmacy to pick up my prescription. Guess what - it needs prior approval. They said they would contact my doctor's office to get this and it usually takes a couple of days.

On Feb 21, I asked the Walgreens and the prior approval had not been received. So I called my doctor's office again and left a message.

On Feb 23, I called my doctor's office again and spoke to some one who assured me she would look into it and take care of it.

On March 3, I called Walgreens and the preapproval still was not there.

On March 4, I called Caremark who handles the prescriptions and preapprovals for Blue Cross and was told that they had faxed the form to my doctor's office on February 23.

Later on March 4, I called my doctor's office and asked where was the form and why it was taking so long. I was told the prior approvals are fairly low on the totem pole because they have too much to do and they usually get them done once a week if not more frequently. They have also tried to call in to the number to get an approval over the phone but that takes 45 minutes of being on hold. But they did track down my form and got it signed and faxed back to Caremark.

I then called Caremark and asked if they had it yet. They said, oh no that takes 3-5 days for a decision either way. Was there anyone I could speak to about the system? No, but I can fill out a form and send it in. Caremark just processes the claims and prior approvals for drugs as specified by Blue Cross.

I then called Blue Cross back and there was no one there I could speak to about the decision. All the prescriptions issues are handled through Caremark.

So it is now a six week procedure to get a prescription approved and filled. This is the insurance company creating the medical run around and forcing more work on to over worked nurses and medical practitioners just to make sure that drugs are being used within guidelines and appropriately.

The drug I am requesting is Mobic (Meloxicam) it is an anti inflammatory. Apparently I am not old enough to need it in the mind of Blue Cross as it only requires prior approval for patients under the age of 55.

I honestly do not think its the doctor's fault that they have to justify a prescription and fill out a form. I see it as a way to have a double check to make sure drugs are being used appropriately and not being prescribed inappropriately, etc. I don't see it as a problem for the local pharmacy, Walgreen's in my case, their instruction is to send it back to the doctor and have them put in the request for the prior approval. I can understand Blue Cross wanting to insure they are paying for drugs being used appropriately.

What I cant understand is that if the Walgreen's computer is connected to the Blue Cross computer which is connected to the Caremark computer and the hospital computer, why does this have to be done by hand or by phone? Why can't it be done online? I will run out of pills in the next few days and will not be a happy camper.

Its an anti-inflammatory that you need to keep built up in your system. So if I go off it for a few days, it will put me behind and in pain. This is a clear case of the medical run around and if anyone who reads this wants to make a big deal about it and put it in national media or something about how insurance companies are running the medical centers and patients into the ground, feel free to let me know and I'll be happy to talk in more detail. Today you can sign me a pissed off, cranky patient who is sick of big conglomerates.

Now its 710PM and my prescription is ready. What happened to the 3-5 business days?

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