I work for this wonderful agency that has a great health insurance package – it’s actually through the state of Maryland. I have the mid-grade package which costs us about $180 monthly for the two of us. With this come substantial savings (considering Gary’s medication alone costs about $1500 monthly) which makes me love and adore our health insurance company and plan. However, we’re also plagued with the need of referrals from our primary care doc for everything we do!
And here, my friends, is where we start to wonder if our insurance is our worst enemy. Appointment #1 at the Maryland Center for MS, they said – we don’t have a referral, we can’t see you! We called and called our PCP office to get them to send one over and they said – it takes 24-48 hours. Mind you we had already requested this and they had given us verbal confirmation that it was sent to the new doc. Can you imagine – our blood boiling – while we listened to both offices say there was nothing they could do!?!?! Here we had already waited 2 months for this appointment, Gary wasn’t on meds yet, and we knew he had to start! Thankfully, there was this wonderful nurse who told our PCP office what she thought of them and got the referral sent over in time. This is only after our Maryland Center for MS peeps had put our info in to the computer so that we got a hefty thousand something dollar bill about a month later. Man i hate that insurance company that didn’t put two and two together.
Then I called them and they settled it all for me and our bill was reduced to the $25 specialty visit copay. Hello again dear friend.
Fast forward, November 2010 – repeat everything I just said above. Seriously. No realy, point for point – missing referral, advocating with the PCP office, getting over billed, etc.
Fast forward, January 2011 – Gary calls the specialty pharmacy to get a refill on his prescription, everything is wonderful. The pharmacy ships everything right to our door (love you). However, this time Gary gets a call back saying he needs prior-authorization since it’s a new year. The doctor had authorized it for one year but for some reason, because there is a 2011 in the date these days they need new authorization. So we call Shared Solutions which is this great company that helps people on Copaxone (the meds Gary’s on) and they can’t do anything because they’re worried if the authorization has already been submitted that it’ll get submitted twice and the insurance company will go whack-a-doodle. So Gary calls our PCP to see if he’s submitted it. 24 hours later and still no call back. 24 hours later and we’re still wondering if gary is going to get his meds in time.
Notes to self:
1. PICK UP THE REFERRAL prior to the next appt at MCMS.
2. Even if you get paid to help people navigate the health insurance system, it doesn’t mean you can navigate when it’s needed for you or your spouse.
3. THANK GOD for the pre-existing conditions clause in health care reform.
4. Our Health Insurance company will ALWAYS be our best friend, and our worst enemy.
Ta ta
Gary's Gang 