Tuesday, I had my regular 6-month nurse practitioner appointment for blood work and prescription refills. Sweet Gummi Mary! I hardly know where to start...
The girl at the desk, behind her protective sliding window, took my insurance card and ID, and said that since this was a "preventative" visit, there would be no copay. What in the Not Heaven? Last time I had the regular $35 copay. And the two times before that, they SAID they weren't taking copays due to the VIRUS, but they sent me a bill for $35 for the second of those two visits. I think they're making it up as they go along. I'll believe there's no charge if I don't get a bill in a few months.
I told both the vitals-taking gal who asked about my prescriptions, AND the NP, that I have to have that one pill brand-name, not generic. She said is was on my file, and the NP said it was as well. "Look. I'm sending it right now, saying DISPENSE AS WRITTEN, NO SUBSTITUTION."
"Well, you used to have to send a letter to get it approved, but that hasn't happened in a year or two."
He agreed that it had not. Of course you know there's more on this topic...
Next I went up to the lab for my blood draw. They were doing it in a different room, around the corner, with a big cushy chair instead of the slick plastic chair with a shelf like a student desk to lay your arm on. The minute she called me in, the phlebotomist said, "Give me your purse."
I wanted to say, "Get your own purse, wench!" Heh, heh. But I handed it to her. I didn't see what she did with it, because I was busy settling into that soft chair, and hurting my right knee by bending it too tight to let her walk across in front of me.
She was not at all friendly. Not even cordial. The sign said to tell them which lab to send it to, and I said, "I'm not sure which lab my insurance wants the blood to go to."
"NOBODY TOLD YOU WHICH LAB TO USE FOR YOUR INSURANCE?"
"No. My insurance changes every year on July 1. I'm a retired teacher. I'm lucky to get a new card in the mail."
At least she didn't hurt when she jabbed me and sucked out two vials. She slapped on a gauze pad and said to put pressure on it, and wrapped my elbow badly with that stretchy stuff that's not tape. Just the beige kind. Nothing colorful. Then she said, "Unlock the door."
I took that as my signal to leave, but I didn't see my purse. So I asked where it was, and she barked, "Hanging on the door!"
Well. Exuuuuuse me! I undid the deadbolt and got out of there.
Later in the afternoon, I got a text from my pharmacy saying 2 of 2 prescriptions were ready. Which is fine. I hadn't actually asked for the refills to be filled. They are usually sent in, and are on hold until I request refills myself. But since there should have been 3, I called the pharmacy to ask where the other one was. Sometimes they have to wait until some come in the next day.
"Let me look that up for you. Oh. We have a new girl. She didn't know you pay cash for that one. So she didn't fill it."
FIRST OF ALL... since when have I been paying CASH without using the insurance I pay a fortune for??? And secondly, if 3 prescriptions are called in, I'd think you would fill all three, and then deal with the payment method when the person comes in.
"Pay cash? I've been paying cash?"
"Yes. Since last September. The insurance won't pay without a doctor verifying that you can't take the generic that's available."
"He told me he put it on there! Just today."
"Let me check. Yes, he put no substitutions. But that's not what the insurance needs."
"So how was I supposed to know that, other than not getting my prescription refilled. Doesn't somebody notify the insurance?"
"We as a pharmacy do not deal with the insurance. That's for your doctor to do."
"How was he supposed to know that it didn't go through?"
"Do you want us to let him know?"
"Yes. How long should I wait to check on it again?" [Trying to be nice, so I didn't call them everyday.]
"I don't have any idea how long it will take. He won't do it now. It's 5:30. He might see it tomorrow. Sometimes it takes 24 hours. Or it might take over a week."
She was not at all nice or helpful. Just condescending, acting like it wasn't her job as a pharmacy technician to deal with insurance for a prescription.
"Okay. I will call over to the office tomorrow and remind them."
Sheesh! I wonder if my insurance has been paying anything on the two generic medicines. Probably. And it would probably be cheaper if I just paid cash...
Why does your insurance change every year and why isn't there a standard lab that always takes the blood draws? Your system is nuts. Not yours personally, your country's system.
ReplyDeleteRiver,
ReplyDeleteYou ain't a-woofin'! Insurance is CRAZY! When we had me, Farmer H, and The Pony all covered through my school policy, it was over $1800 A MONTH for the insurance premium! Now I'm the only one on it, and it's still over $700. Yet the school secretary told me that is actually cheap compared to other plans!
It changes every year because Newmentia is part of a consortium of schools in the area, and they always try to get a better deal when the current provider tries to raise the prices. There are two main labs, and our insurance usually can be done through both of them, but the rep who used to come hold our end-of-the-year meeting (when we had a chance to switch plans within the provider) would tell us to be sure to send it to THIS ONE or you might have to fight with them.
For the past two years, there's been no end-of-school meeting. They just tell people to go online to read the policy, and order extra ID cards if you need them. Nobody ever says which lab to use anymore.
My theory is that we all pay so much because some people get treated for free (can't turn anyone away from the ER), and the medical facilities need to get their money somehow, so they negotiate with the insurance companies, who pass those charges on to US. There's a different price at most facilities and doctors if you pay without insurance. Insurance gives you "the negotiated price" which makes it look like you're getting a big discount. When in reality, the facilities jack up the price they charge insurance companies.
I admit, my tone with the needle-sticker (AFTER she finished with the draw) would be less than civil after that experience. I would also report her to the clinic/hospital/practice. it probably wouldn't do any good, but at least it would give me some satisfaction.
ReplyDeleteI also would let loose with some colorful comments once I got back into my car.
Sioux,
ReplyDeleteI couldn't do the car part because Farmer H drove me. But I did a lot of underbreath muttering as I left.
I DID call and complain, and wrote a follow-up letter for the time I woke up during surgery, and heard the nurse saying some uncomplimentary things while I was unable to move or talk. That got me a personal call from the nursing supervisor, who said OR records verified everything I said I overheard that wench say. Her mistake was in mentioning other doctors that day in other operating rooms. The supervisor said she was going to use my letter in a training session, to emphasize how nurses might THINK patients couldn't hear them, but should act as if they could.