So yesterday morning I’m sitting here and I get a call from my insurance that the expedited review for ancillary services, a.k.a. the infusion, has not been deemed necessary. Therefore the review will be conducted at the usual standard time as per policy. WTF???? I thought the problem was they didn’t order the drug? Turns out they never got authorization to get the drug or to administer it.
Authorizations have to go to my doctor. My first step started when I called the insurance company. They told me it was never expedited, I shouldn’t have received a phone call it was denied. To get it expedited I needed to call my doctor’s office and have them request it. I called my doctors office, they are so wonderful there, thank God, however they never started the authorization process. So now we had to go back through the infusion center to find out who is doing what!!! This only took about seven phone calls back-and-forth but finally we got the answer send the forms over to get the review expedited as soon as possible. Great, or so I thought.
On a completely different thing I decided to refill some of my every day medicines. I was getting a message saying to please contact my pharmacy because my insurance card on file has expired. Not knowing what that meant, I decided to make a phone call. They informed me that the system was saying I am no longer eligible with my insurance, emblem health.
Since I am state health insurance, I first have to do my renewals through New York State Medicaid. Once that’s approved their system is updated which update the file for emblem health. Well for some reason I received a notice of discontinued from Medicaid in error this month. I got it all straightened out immediately and it was all fixed but guess what, the screens weren’t updated so the insurance company had me as not eligible. I then had to sit on the phone with them for another hour while they contacted the state to find out that I was truly still eligible. They needed to verify that my recertification for the year was actually done and then their system needed to be updated. However insurance isn’t quite as easy as that either and she had an out expedite the updated insurance screens with her company. As of end of day yesterday the still wasn’t done.
Ironically in the middle of all this I get a call from the authorization department telling me that my ancillary services was authorized. The pharmacy called me and said because my pharmacy services are ineligible if they order the medicine and something doesn’t come out right I am legally responsible for the price of Ocrevus, would I like to wait until the insurance is fixed before they order it? I told them no, please order the medicine so I can get this done because I know I am eligible and everything will be fine.
I literally was on the phone with all different parts of my insurance for the entire day yesterday. It’s a good thing I don’t have a full-time job, because this is my full-time job. Can you imagine? I can’t make this stuff up.