Yesterday I authored a post expressing my utter frustration with insurance, Medicare and a recalcitrant provider system, so we went to work on the phones for a couple of hours. We started with my very patient Doctor’s office, all of whom have to be in counseling over the handling of the governments so called “bridge” program. This program is designed for old people like me to gain access to the GLP-1 medicines to manage weight. You must meet a couple of requirements related to health to qualify, conditions that most of us are familiar with. There was some urgency as when I became involved in this quest, the prescription for Zepbound I was taking at my own expense was cancelled. Competent physicians and insurers frown on multiple Rx’s for a given med. If enough time lapses between doses of these meds……you start over with micro doses……the physiology is the domain of medical specialists, not me. Thus the urgency
The issue was simple. I could not find exactly where my new Rx was in the food chain. It was the tweed ring on steroids, everybody pointing at someone else as the cause in the delay. Sharon and I began working the phones, asking pointed but reasonable questions, always polite and deferential. I know when I am being blown off and, well, Sharon is a walking polygraph. Answers were like assembling a picture puzzle with pieces from different boxes.
We determined that Mercy Medical relies on an in-house “prior authorization group” to obtain prior approval. The system has your records and they can do the research, submit the forms and make life easier. This is a secret place. The word is mum and they will not tell you what is going on with a given request, however you can plant the seeds of discontent. We also managed to get to the right person in Mercy administration which immediately prompted their dive into the problem on our behalf. Next is our insurer. They could not have been nicer or more efficient but knew virtually nothing except that Medicare had to approve this med and then they would cover it. Next was Medicare where you need a law degree, medical degree and the tenacity of a bulldog with a toothache. We finally learned my request had been received and was in queue……
The conclusion to this novel. We must have stepped on the right toes as suddenly my pharmacy received the documentation necessary to fill the script under the bridge program. I will have the med Monday.
The saga isn’t over. Out of concern for a gap in using this medicine, I thoughtlessly ordered the med from one of the recommended online providers, sent my money and, on the same day, tried to cancel the order because the bridge came through. Their adds say you can cancel anytime but they don’t want to refund my payment for a 3 month supply. Believe me, they will or I will turn their lives into a living hell online. I DO NOT recommend you go this route and I did so against the sound advice of both my physician and pharmacist. PM me and I will explain why, beyond the obvious.
Thanks for indulging me and maybe this treatise will help you. I abhor incompetence and was subjected to it in this process. In summary, the problem lies with Medicare, not my provider, not our insurer and not Mercy systems. all of this occurred yesterday, a day’s work.
The squeaky wheel gets the oil!
Steve
srj641 