Insurance: Scams and Other Problems

On Friday I had to renew a prescription I’ve been getting for at least three years.  I was out of refills.  I called the mail order portion of my medigap insurance and was given as much information as the tech could give me, although it did nothing to help me order the damned drug, which is all I was attempting to do.  He couldn’t deal with medicare issues.  I hung up, and called the new number he had given me for the mail order portion of the insurance that could deal with medicare patients.  All in all I spent forty-five minutes on the phone with three additional techs all of whom gave me contradictory and different information.  I finally gave up.  I had enough to last me a few more weeks:  enough was enough.  On Sunday I sat down to try again.  Five different operators, misinformation, distress for me, and anger.  I ended up raising my voice, and even yelling at two of the operators.  I have no idea if it was their fault, or if they were indeed trained to set up the order so that you would have to pay more.  I also discovered, whether bogus or not, that I had to pay full price for the drug because it wasn’t covered by my insurance.  By the time I hung up I was in tears.  One of the phone people had mentioned that there was a problem because my local doctor had order me a 32 day supply at the local pharmacy, which had been filled.  Today, Monday, I called the pharmacy, and indeed the nurse had ordered my supply from the downtown pharmacy. The pharmacist told me that the insurance company does pay a portion of the cost if you use a local pharmacist. The mail order portion makes more money if they convince you to purchase the stuff in the way they tell you to, which could be any way that makes them more money!  They also should cover the drug, which is a Tier 3 medicine.  I ordered the medication from the local pharmacist, a drug taken by almost all the women over 65 that I know, but will now be paying half what I used to pay for this stuff at the mail order place, same insurance company.  What a scam!  And how infuriating.  Isn’t there any government oversight on these mail order places? On these insurance companies?   Guess not.  My persistence (and loud voice) irritated my partner no end, but I bet most older women just give up and continue to pay too much because dealing with the mail order medicare facilities is just too confusing, too irritating, and too difficult to fight.  I suppose I shouldn’t have raised my voice, but I sure am glad I persisted. And sometimes, I think, getting angry is called for. I am relieved that I thought to call my doctor’s office as well as the local pharmacy this morning.  Now the nurse knows to suggest to other patients who use the drug to shop ‘local’. Good for the town, and bottom line, way better for the patient. And me!