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Don’t get me wrong, I am very grateful to have health insurance coverage – period.  I would not be able to afford the medical care that I need for keeping my RA under control.  But I’m certainly not going to ask my health insurance company to be my Valentine this year.

I thought I’d share a little story with you about a very tedious and unnecessary process I went through for just one of my many pharmacy claims the past couple weeks, since it is oh-so-very-interesting.

  • Step 1: June came along and naturally, I ordered my monthly prescription refill through my Specialty Pharmacy for a new bio-med called Enbrel.  This prescription costs roughly $1500 per month out-of-pocket (now you know why I have a hard time spending $4 on coffee at Starbucks).
  • Step 2: All goes according to plan, the Enbrel was delivered and my health insurance was billed for the prescription.  My patient assistance program, Enbrel Support, was then billed for the remaining copay amount, so my total responsiblity was zero.
  • Step 3: Six months later, I received a bill in the mail from my Specialty Pharmacy for the “patient responsibility” of $230 for that June order.  WTF?!  It was supposed to be zero!
  • Step 4: In my frustration, I called the Specialty Pharmacy and asked why they didn’t bill the Enbrel Support program.  Three customer service reps later, I finally found out that Enbrel Support was billed and this amount was still due on the order.
  • Step 5: As you can imagine, I called Enbrel Support and once again I got transferred back and forth between numerous reps to get to the bottom of it. And the bottom of it was that my patient assistance funds ran out.  I was definitely not aware that this program had a limit to the amount of money they helped the patient with, but now I do [sigh].
  • Step 6: So I called back the Specialty Pharmacy and told them to bill another patient assistance card that I had remaining available funds.  Bad news is that the Specialty Pharmacy could only bill a maximum of two insurance cards per claim.  (When did they make that rule?!)  Now the patient – or should I say the victim – is stuck with this bill, which is just not fair.
  • Step 7: I called my second patient assistance customer service number for options.  And just create more work and stress for the patient on this, my only option is to fill out a manual claim form for the June order – after I pay the Specialty Pharmacy in full of course.  (By the way, I made that call over two weeks ago and I am still waiting for the claim form to arrive via snail mail.)
  • Step 8: In the meantime, I set up a payment plan with the Specialty Pharmacy so they don’t send me to a Collections Agency (those guys are scary).  Add it to my list of 7 other monthly payment plans I currently have with doctors, hospitals and pharmacies.

And there you have it.  Just one of the many reasons why my health insurance company will be single this Valentine’s Day, because they are definitely not on my “love list”.

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