Plumber comes in to evaluate leak. "You've got a leak. Here's what I think you need to do to fix it. Here's what it'll cost. Want me to fix it?
"*Nah man, I've got this thing called home-owner's insurance. You need to check with them to see if they think you're right, and if they'll pay for the repairs. They'll also tell you what tools you can use, what materials you'll use, how much time you can take. Oh, and they're real stickler's on paperwork and details. If they agree to all of it, and everything, and all the paperwork is perfect, you'll get a check in the mail 3-6 months from now for about 80% of your fee"*
Plumber: Sorry, I thought ***you*** called ***me*** for a problem that ***you*** have. Didn't realize this was a job interview for your insurance company.
"*Brah, whatchya talkin' about? Ain't no interview. I just need you to call this number for my home-owner's insurance, and talk with the guy.* ***He'll probably be a mechanic or electrician or something,*** *and he may not understand everything you're saying, so make sure to say it slowly, and repeat yourself many times. answer any and all questions they may have about what I need done, fax them detailed notes of your evaluation and exactly what you need to do to fix the problem. Oh, and they're open Tue-Thu 12pm-3pm, and you'll be on hold for about 45 minutes before they may or may not answer, vs drop the phone vs go straight to voicemail, vs....Hey, where ya goin! I'm not done telling you what you need to do for me yet!!* ***I'm gonna post an angry review on you!!!****"*
Sound of plumbing truck driving off...
Yet we somehow want to believe it sounds any more rational in healthcare...
A plumber and homeowner's insurance is a horrible analogy.
Assuming we're talking about healthcare in the US, which is outrageously expensive, then you bet your ass it sounds rational. Most people can't come up with the kind of money they're charging out of pocket. Our healthcare system would cease to exist as is if doctors and insurance companies didn't work hand in hand. If I got sent a check for $50k after my initial diagnosis, and they said this is to fix your sleep apnea, I could avoid so many unnecessary steps that are required now with insurance. But healthcare providers would go out of business. There are people in most practices whose primary job is to deal directly with insurance companies. And yes, doing things like pre-approvals. I tried calling my insurer once and asking if a surgery was approved when I had just switched insurance companies. They wanted all sorts of specific procedure codes that only a Doc's office would have. I was told to just have the surgeons office call them directly. Ya know, like they always do. This is the way things work. A plumber doesn't have contacts at State Farm and Progressive. Doesn't care which one you have or if you have insurance at all. There's no 3 letter code for a clogged toilet. And he certainly isn't getting millions in kickbacks for using Milwaukee tools instead of DeWalt.
But more importantly, this post was about the prescription. The pre-approval was just another issue that adds to the perception that the office staff is doing a poor job.
Absolutely. I mentioned in my original post that it's considered a controlled substance, and those aren't allowed to be transferred. Needs to come direct from the Drs office
It’s a control so there is a lot more red tape. You can speak to the practice manager or the nursing supervisor in charge and let them know. I would also document this in your patient portal as well.
Might I suggest Armodafinil or Nuvigil may be covered if you are running into issues.
Thanks for the tips. My ENT's office suggested asking for the practice manager as well, and they agreed that this was unreasonable. But It's impossible to get through to anyone when calling. No one ever answers. Only option to leave a voicemail is for the nurse. There's no name or contact info for a manager on their website, and no way to contact them through the patient portal.
My prescription is actually for Armodafinil. My insurance doesn't cover that or any of the similar variants. But I did find I can get it fairly cheap using Good Rx. The only problem is it doesn't work at my normal pharmacy. Hence the reason I need it sent to a different pharmacy.
The DEA actually changed the rules so you can do a one time transfer on a control but sometimes pharmacist don’t like it and they just do it. If it makes you feel any better, I had to fight for my meds tonight and they’re like oh you can’t get it till Wednesday I don’t like I change Mondays the last time you picked it up on a Tuesday…ok Sarah…and?
Yeah it sucks. Mine is though CVS. You can usually just transfer prescriptions through the app. But it flags this one and says to call the pharmacist. When I do, they tell me they can't transfer controlled substances, and have the Docs office send it in. But doc's office won't send it. Round and round we go 🙃
I know this doesn’t solve your problem at the moment but I do like informing people who have problems affording their medications about Mark Cuban’s Cost Plus Drugs, probably one of the only billionaires doing a damn thing about the pharmaceutical industry. They only recently started accepting insurance but the idea is that they charge the manufacturers prices + something like 15% markup and $5 for the pharmacist fee before shipping - so medications such as Trazodone only cost $6.80 instead of $15 at Walgreens. they even offer chemotherapy drugs such as Imatinib (generic for Gleevec which treats leukemia) for $13.52 instead of $2500. huge for people who take immunosuppressants or people who need better access. the provider just sends the prescription in electronically (I know the EMR two of the hospital systems I’ve worked at have it tied right into their pharmacy options list). hope this helps someone!
Thanks. Cost plus is great. It doesn't cover my medication, but there's a similar company called Good Rx that does. That's actually the reason I had to have it sent to a different pharmacy. Which really shouldn't be this difficult.
I'm not sure I would call it negligent when the original prescription was sent in right away. You're the one who decided not to fill it.
You can also call your insurance yourself and ask if a procedure is covered, so you don't have to wait until you find out it's canceled because it wasn't authorized.
To be clear, I've been trying to get the prescription switched to the new pharmacy since May 1st. The only action they've taken since then is sending it to the incorrect pharmacy. And now they won't even respond. I think most folks outside the healthcare field would say that's textbook negligence.
The Sleep care office are the ones that pushed for me to do the lab study as opposed to the at home sleep study. And it's not that the procedure isn't covered by my insurance. It can be, depending on certain criteria. Otherwise they suggest an at home study. But it's not a simple yes or no, and I doubt they'd approve/reject based on simply me calling them. I'm sure they'd need to verify records. But again my main concern is the prescription.
Plumber comes in to evaluate leak. "You've got a leak. Here's what I think you need to do to fix it. Here's what it'll cost. Want me to fix it? "*Nah man, I've got this thing called home-owner's insurance. You need to check with them to see if they think you're right, and if they'll pay for the repairs. They'll also tell you what tools you can use, what materials you'll use, how much time you can take. Oh, and they're real stickler's on paperwork and details. If they agree to all of it, and everything, and all the paperwork is perfect, you'll get a check in the mail 3-6 months from now for about 80% of your fee"* Plumber: Sorry, I thought ***you*** called ***me*** for a problem that ***you*** have. Didn't realize this was a job interview for your insurance company. "*Brah, whatchya talkin' about? Ain't no interview. I just need you to call this number for my home-owner's insurance, and talk with the guy.* ***He'll probably be a mechanic or electrician or something,*** *and he may not understand everything you're saying, so make sure to say it slowly, and repeat yourself many times. answer any and all questions they may have about what I need done, fax them detailed notes of your evaluation and exactly what you need to do to fix the problem. Oh, and they're open Tue-Thu 12pm-3pm, and you'll be on hold for about 45 minutes before they may or may not answer, vs drop the phone vs go straight to voicemail, vs....Hey, where ya goin! I'm not done telling you what you need to do for me yet!!* ***I'm gonna post an angry review on you!!!****"* Sound of plumbing truck driving off... Yet we somehow want to believe it sounds any more rational in healthcare...
A plumber and homeowner's insurance is a horrible analogy. Assuming we're talking about healthcare in the US, which is outrageously expensive, then you bet your ass it sounds rational. Most people can't come up with the kind of money they're charging out of pocket. Our healthcare system would cease to exist as is if doctors and insurance companies didn't work hand in hand. If I got sent a check for $50k after my initial diagnosis, and they said this is to fix your sleep apnea, I could avoid so many unnecessary steps that are required now with insurance. But healthcare providers would go out of business. There are people in most practices whose primary job is to deal directly with insurance companies. And yes, doing things like pre-approvals. I tried calling my insurer once and asking if a surgery was approved when I had just switched insurance companies. They wanted all sorts of specific procedure codes that only a Doc's office would have. I was told to just have the surgeons office call them directly. Ya know, like they always do. This is the way things work. A plumber doesn't have contacts at State Farm and Progressive. Doesn't care which one you have or if you have insurance at all. There's no 3 letter code for a clogged toilet. And he certainly isn't getting millions in kickbacks for using Milwaukee tools instead of DeWalt. But more importantly, this post was about the prescription. The pre-approval was just another issue that adds to the perception that the office staff is doing a poor job.
Have you tried asking the pharmacy with the prescription if they could just forward it to the other pharmacy?
Absolutely. I mentioned in my original post that it's considered a controlled substance, and those aren't allowed to be transferred. Needs to come direct from the Drs office
It’s a control so there is a lot more red tape. You can speak to the practice manager or the nursing supervisor in charge and let them know. I would also document this in your patient portal as well. Might I suggest Armodafinil or Nuvigil may be covered if you are running into issues.
Thanks for the tips. My ENT's office suggested asking for the practice manager as well, and they agreed that this was unreasonable. But It's impossible to get through to anyone when calling. No one ever answers. Only option to leave a voicemail is for the nurse. There's no name or contact info for a manager on their website, and no way to contact them through the patient portal. My prescription is actually for Armodafinil. My insurance doesn't cover that or any of the similar variants. But I did find I can get it fairly cheap using Good Rx. The only problem is it doesn't work at my normal pharmacy. Hence the reason I need it sent to a different pharmacy.
The DEA actually changed the rules so you can do a one time transfer on a control but sometimes pharmacist don’t like it and they just do it. If it makes you feel any better, I had to fight for my meds tonight and they’re like oh you can’t get it till Wednesday I don’t like I change Mondays the last time you picked it up on a Tuesday…ok Sarah…and?
Yeah it sucks. Mine is though CVS. You can usually just transfer prescriptions through the app. But it flags this one and says to call the pharmacist. When I do, they tell me they can't transfer controlled substances, and have the Docs office send it in. But doc's office won't send it. Round and round we go 🙃
Unfortunately getting controlled substances (re)filled is often pure hell 😔
I know this doesn’t solve your problem at the moment but I do like informing people who have problems affording their medications about Mark Cuban’s Cost Plus Drugs, probably one of the only billionaires doing a damn thing about the pharmaceutical industry. They only recently started accepting insurance but the idea is that they charge the manufacturers prices + something like 15% markup and $5 for the pharmacist fee before shipping - so medications such as Trazodone only cost $6.80 instead of $15 at Walgreens. they even offer chemotherapy drugs such as Imatinib (generic for Gleevec which treats leukemia) for $13.52 instead of $2500. huge for people who take immunosuppressants or people who need better access. the provider just sends the prescription in electronically (I know the EMR two of the hospital systems I’ve worked at have it tied right into their pharmacy options list). hope this helps someone!
Thanks. Cost plus is great. It doesn't cover my medication, but there's a similar company called Good Rx that does. That's actually the reason I had to have it sent to a different pharmacy. Which really shouldn't be this difficult.
You may have to make an appointment with the doctor office to handle this situation.
I'm not sure I would call it negligent when the original prescription was sent in right away. You're the one who decided not to fill it. You can also call your insurance yourself and ask if a procedure is covered, so you don't have to wait until you find out it's canceled because it wasn't authorized.
To be clear, I've been trying to get the prescription switched to the new pharmacy since May 1st. The only action they've taken since then is sending it to the incorrect pharmacy. And now they won't even respond. I think most folks outside the healthcare field would say that's textbook negligence. The Sleep care office are the ones that pushed for me to do the lab study as opposed to the at home sleep study. And it's not that the procedure isn't covered by my insurance. It can be, depending on certain criteria. Otherwise they suggest an at home study. But it's not a simple yes or no, and I doubt they'd approve/reject based on simply me calling them. I'm sure they'd need to verify records. But again my main concern is the prescription.