Wednesday, November 18, 2009

I was RIGHT!!!


So, I have had an AWFUL time with the insurance company lately.

In SEPTEMBER I tried to order my prescriptions for the first time since switching insurances. When I was checking my prescription account at Caremark I realized that they were trying to ship all the prescriptions to me at once (which is a HUGE bill!). They didn't call me to ask what ones I wanted filled or to even let me know they were being shipped.

I just asked for my prescriptions to be transferred to the pharmacy, that was it.

Anyway, I was looking at the prescriptions they were trying to ship me and realized they were trying to ship me the wrong Infusion Sets.

Fast forward 3 weeks later I have been trying to call and figure out how to get the RIGHT ones for the last 3 weeks. I had been told that the Prescription Plan did NOT cover the infusion sets but the Insurance Plan did under Durable Medical Equipment - and back and forth I went with Representative to Representative. Being told one thing then a contradicting one.

I finally called Animas up and they were SO very helpful. Told me that they were in fact covered under DME (Durable Medical Equipment). Silly me didn't ask them to check on the prescription plan. I called BACK to Caremark (the Prescription Plan) and asked them WHY they had been in the process of shipping me Infusion Sets when they were not covered.

Evidently that was the right question AND I finally got a hold of the right person. I did make sure this time to explain everything very slowly, articulately and phrased in a very specific way so no mistake in what I was saying could be made. He told me that the proper Infusion Sets were actually covered! He apologized over and over for his Colleagues and their lack of knowledge about their profession. It was nice finally getting a competent person to talk to!

So, I was right. I knew they would be covered being as I was going to get Infusion Sets in the first place, although they were the wrong ones, there should have been no reason to deny Infusions sets made by the exact same company - just a different type!

I wish people would actually care about their jobs enough to learn about the things they are supposed to help people with! Especially in the medical world!

I'm beyond thrilled now, I would have had to meet a Deductible for the DME supplies - which would have hurt pretty bad.

Next step: Getting the right Prescription Written from my Doctor that wrote it wrong in the first place!!!

2 comments:

Layne said...

Wow, that sounds SOO familiar!! ;-) Being transferred from department to department always being told that "we don't cover it, call those other guys, they cover it." Well, SOMEONE has to cover it!!?! Drives. Me. Crazy!

I hate insurance companies. Seriously, hate them. But I guess they are a necessary evil. Can't live with 'em, can't live without 'em.

Go you for fighting the good fight!

Suzanne said...

Uuggh! This really does sound like a total nightmare... if they'd just do what they are supposed to in the first place they'd save themselves a lot of time, energy, and money! So much wasted in the run around!!! Glad you got it figured out though! What a relief!

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