Yesterday, during a National Holiday, our pharmacy (one of two in the city that handles these type of meds) called to tell us that Gage’s Cellcept and Prograf couldn’t be approved because our insurance company – BCBS – is requiring us to order these two meds by mail order. Which really, in the big picture, wouldn’t be a problem, except that we typically order them a day or two before we need them. So we need Prograf on Wednesday morning.
To pay for 4 days of them out-of-pocket is nearly $130.00, so that’s not a great option. Four days might have bought us enough time to get mail order meds in by when we need them.I actually have no idea how long mail order meds take to get set up or processed.
BCBS didn’t send us a warning this would happen. Not one letter, not a call, not an email to let us know this was coming. This completely sucks. Because after I made 5 phone calls to the new mail order pharmacy (as directed by our local pharmacy to call) they didn’t know what to do with me so I got moved and moved to talk with different people. And the people there have no connection to the benefits and or approvals for out of ordinary situations.So they directed me to call BCBS to figure it out.
I need for BCBS to approve these two for a month so that I can do what I need to over the next month. This is the kind of thing that slows the process and takes time, that bogs down the caregiver. Because if you think about it, all the things I do to manage the kids’ care have this same process. Get rejected, or transferred, call, wait, get direction, call, get switched, get forms, call, wait, call again, call someone else, file, get fax, etc., etc. It’s a vicious cycle.
And it begins with companies not really caring what I have to do to get it done. As long as I have pre-approval. And they make that so easy.
Easy breezey parcheesy. As Quinn would say.
While I am extremely grateful that we have good insurance, it also, at times, makes me want to pull out ALL MY HAIR. You have my sympathies. I wish there were something I could do to help.
We’ve been using the mail order pharmacy for almost two years. the only problem we have with mail order is thier window of opportunity for refilling a med is narrow making it difficult to get multiple meds in the same shipment, or planning for an extended vacation. Other than that it’s a breeze. It will save you courier bucks over the long haul. Pun intended.
Hey, let me know if you need help deciphering insurance stuff. They usually mail out amendments with tiny writing that tells of all the changes to a contract. My health insurance head might be able to intrepret what they will mean for your kids care. And of course I am a little defensive since it is my livelyhood but there are medical reasons proven by studies of why some treatments are better at certain points or to treat certain things. But I understand the emotions of watching a kid suffer also.
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