Comedy of flipping errors! That’s what our lives have been like for the past week/week-in-a-half. I am grateful that the boys have medical/dental coverage. I’m extremely grateful where we can’t help them the state is able to. However, trying to get a PA for a medicine where the benefits outweigh the risks for an 11 month old that the insurance won’t cover until they turn 1 is a freaking nightmare!
I have gone back and forth between the insurance’s PA department and the Pediatrician’s office trying to figure out who is wrong and what is going on. The PA department told me the Rx needs to say benefits outweigh the risk. I told the ped’s nurse that last week, the boys were prescribed their meds on the 20th of last month. I waited in the pharmacy’s drive-thru line for almost an hour just to get up to the window and hear, “we’re still waiting for the pa to come through. I’m sorry.” What now! What do I have to do to get this taken care of? I know there is nothing more the pediatrician can give my youngest, because of his age, until we have this script and see how he does. His allergy meds have helped where they can work, but now there is a cough, both him and his brother have it really bad, and anyone who has kids knows that infants, and probably up to two years old, can’t have expectorants. It’s just not safe. The risks outweigh the benefits on this one.
So I called back the PA dept on Monday.
Me: “I told the pediatrician’s nurse what needed to be on the Rx, but the pharmacy is still saying they need a PA. I’m not understanding what more needs to be done.”
PA: “The pediatrician or nurse needs to go to our website and fill out a form. Then they need to fax it to our Pharmacy PA dept.”
Me: “Why wasn’t I told that the last time I called. I was only told about what to put on the Rx.”
PA: “I’m sorry, but that’s what needs to be done now.”
Really? So I called the pediatrician’s office on Monday to tell them what needs to be done. The regular nurse is on vacation so the other nurse told me she had already done all of that and is just now waiting to get a response. I should be able to pick up the medicine soon. I called the pharmacy the next day. Still the same song. So I called the nurse. “We haven’t heard anything back yet. I’m going to resend it.”
Everyone has been extremely accommodating. The problem is the left hand doesn’t know what the right hand is doing.
Now on to LB. LB’s coverage wouldn’t allow for the same medicine, so I called that insurance’s pharmacy specialists and asked what alternative medicine he can have that is covered, mind you this was all done on the same day I started this PA mess with BB. I was so thrilled when they told me there was an alternative and that they covered it. It didn’t dawn on me that what she said as an alternative for the steroidal nose spray was a steroidal inhalant. I had already picked up the medicine. Really??? In what world does this make sense!
I let the pediatrician’s nurse know what happened. We were both baffled. Neither of us had caught it. I was just so thrilled that my son was going to have a medicine that was covered, and not going to cost us nearly $200 out-of-pocket, that I think my excitement had spread and no one was thinking. No one is at fault here, except for that insurance’s PA rep.
Still fighting with the pa, my boys’ coughs are getting really bad, so I made an appt for them to see the pediatrician this morning. I am sure that our pediatrician is extremely grateful to have a new pediatrician practicing with her, especially since she’ll be having her third, I think third, baby later this year. Imagine you are talking to Tara from True Blood, I mean she looks almost identical to the actress, but about 6-foot, maybe 6-foot-1, with the quiet disposition of a kitten. Another words the complete opposite personality of Tara. This woman is quiet but direct and extremely sweet. Plus she loves cloth diapers! Not that our other pediatrician doesn’t, but it was just nice to hear. She is like our pediatrician’s twin in personality. We are extremely grateful on that front.
I explain to her what’s going on with the boys, from the last month of allergies steadily getting worse, the PAs, and the constant coughing that is never-ending, keeping them up all night where no one is getting any rest. The two pediatricians talk about the PA and what is going on with that front. She recommended a chest x-ray for my oldest to check for pneumonia, which scared the crap out of my husband. His brother was about the same age as my oldest when he nearly died from pneumonia. Luckily he doesn’t have pneumonia and a Rx for a different steroidal nasal spray was sent to the pharmacy.
Almost to the present. I called the pharmacy later in the morning to see if LB’s script was ready and if it would be covered by the insurance, our main concern, and if BB’s PA had gone through yet. They said to call back in half an hour when it had actually been processed through and that the PA hadn’t gone through yet. Three hours later I decided on a nap, but I had to call about BB’s PA. They look up in their system and tell me that the Pharmacy PA dept hasn’t received anything. So I called the peds office and left a message for the different nurses about one baby’s pa and the other’s x-rays.
I was woken up by a phone call. LB’s Rx, the original steroidal nose spray prescribed last month, had been approved. What??? I asked about the new script I had called about three-four hours earlier. Now I’m being told that was never in the system and the person I had talked to earlier wasn’t there so they didn’t know what was going on. I called the nurse to find out if they wanted him on the original Rx or the new one and to tell them what BB’s PA rep had explained to me.
The nurse was irritated because they had faxed off three different letters now, each one going into greater detail why BB needs this medicine. Each time it went into greater detail because the receiving end would return the letter stamped denied and a reason. I suppose you could say it needs to be put in a specific way that dot’s the insurance’s i’s and crosses their t’s. So they’re fine with LB getting the original script and asked me to call the PA dept to find out what they need to do because no one is telling them what needs to be done.
I called the PA dept back, explained to them that what is in their computer is wrong because two different nurses have faxed off three letters stating why the benefits outweigh the risks and have received responses each time saying denied. They are putting down exactly what they are being told to put down, yet it is still being denied. The rep said that none of that is in their system so the nurse needs to call the Pharmacy PA dept, which they won’t do until the morning because it was already late and I have no qualms about that, to find out what is going on.
Now I’m waiting in the line to pick up LB’s spray and allergy medicine, a script I requested refilled two days ago. I get there and they said they couldn’t refill the medicine because I had already had it refilled the 20th of last month. Wait…what? Where was I? LB’s allergy medicine is out. So either they shorted us pills or somebody screwed up. The pharm tech is on the phone with the insurance and I’m on the phone with DH. I asked him to find the bottle and to tell me what the fill date was and how many. It was filled in August, not Sept 20 like the pharmacy had in their system, and for 30 pills. So we weren’t shortened pills and we hadn’t picked up a new bottle any time soon. I had DH look at BB’s Rx bottle to check that date and to see if maybe there was a refill sitting in the medicine cabinet. BB’s was refilled the 20th and there were no more bottles. So the pharm tech had it taken care of and was able to give us enough pills to last until the refill date. My happy butt is driving home with a gallon of milk and these much-needed Rxs.
This mess has really driven me crazy. From fevers, to coughs to this ridiculous mess with PAs. I haven’t even hit the best part. DH is putting the scripts away and sees a still stapled script bag under the medicine cabinet. “Wait…don’t tell me this is it.” He just looks at me with this grin. “I was looking for a bottle. Not a bag.” I’m ready to scream, shout, punch a hole through the freaking wall. He opens it and pulls out this blue-bottle of allergy meds…Have I mentioned how much I love my life right now? So now I am going to make my calls in the morning and profusely apologize to the pharm tech for this headache I have caused.
Ugh…am I really that daft?