Friday, May 20, 2011

Some of the medical insurance issues I have to deal with way too often.....

Medical insrurance issue number 1

Anyone else out there have issues with their prescription provider ? Basically we are being forced to use only Medco a mail order prescription provider thru my husband's employer. We get several medicines thru Medco- mostly not by our complete choice...sort of a push. Let me is much cheaper to use them for prescriptions that are on going for chronic issues like ADHD or a heart medicine Luke has to take. I have resisted for years switching some of our meds over to this but now I am being told that the medicines will cost us even more to use if we continue at our local pharmacy instead of Medco.  I take a HRtherapy and Tricor meds. with Medco. I love our local pharmacies because they give very personal care and consideration to our multiple needs... I often call them about dosing issues or is there another option and they always take the time to address my questions. They are an important part of our ability to care for our many special needs children.

Now on to just one of the issues I have had with Medco. This am I called in my refill for my Tricor thru their automated line...after looking closely at the bottle I notice that my old primary care doctor was the prescribing doctor for the last refill in March 2011. The problem is he has not been my doctor for over 5 yrs and should never ok or even be asked by Medco to approve my refill....I have spent over 2 hrs dealing with this very upsetting issue with Medco and my personal doctor and the other doctor. Neither doctor has any record of being sent by Medco a fax for my refill in March...So why did it get refilled and why under a doctor who is not my doctor...Imagine a doctor okaying a medicine for someone who is not his patient or Medco refilling a prescription based on a doctor who is not the patient's doctor...Thank God it is only Tricor this time...what if it was the heart medicine Luke was on and should not have had it refilled....I shudder to think of how many other prescription mistakes Medco makes or even doctors....I manage all of our medical issues but it sure takes a lot of time because the insurance companies can really do a better job or change their systems to catch these issues.

Medical insurance issue number 2

Mya was hit by a soccer ball 2 weeks ago on her knee that just had surgery. Her stitches were disolving and by her bath time I could see an infection starting in them. She had a round pink spot over her knee and it was warm to touch. Of course this was on Sat. nite at 9:30...I called the hospital and asked for the doctor on call for Dr. Standard...  I got a call back from a doctor I did not recognize and he said he did not know of Dr. Standard...I asked him questions about things he should have been aware of for the orthopedic on call...Finally he agreed with my assumption the operator had made a mistake. He could only give me advice and I knew in my momma's heart she needed to be put on an antibiotic...So I called back and got it corrected and sure enough the correct doctor agreed with my assumption....

Medical insurance issue number 3

We have lots of kids...So yeah we have more than the average family ( 27 kids ) but we can not be discriminated against for the number of children we have. Our insurance company has had a problem keeping all of the kids listed every week on our plan...I will go to see a doctor and they run our card thru and it will show that child was terminated . You see Aetna does not have a computer program for the number of dependents we have with their solution is to have one person input our family names every Monday into their system...other families they don't do this way....Actually Hewitt is the provider who inputs the family members names to Aetna ...So why is it that for over 3 yrs I often go to a doctor and I am told that my child's coverage has been terminated...Well once - the person who does that inputting was on vacation. Now I have offered to do this for them for free :) Really I have. Fortunately all of our doctors and there are several know our family well and are ok with my reason for why this happens...But don't you think that an insurance company as big as Aetna is could get this right ? 

Don't get me wrong I am grateful for our insurance and all we have been able to do for our children but it has taken up lots of my time to work things out and now I have another thing to make sure is correct...that the "real" doctor is the one who refills our prescriptions.


Mom to Mine said...

Aetna terminated my son and I back when we still had them as insurance. Took them over four months to get it right and at that time we were only a family of four. I know my husband and I called them at least 10 times over that and then our Dr. had to resubmit everything they refused to cover. They really were awful. I also do not like having to do mail order medicines. Its such a pain b/c our doctors would refuse to use the fax for medco so I had to obtain a script via mail or in person if I needed a new one and then mail it myself. So yeah... Grrrrr!!!!

Kathleen said...

I am so thankful for our pharmacists. My children have complicated medical stuff and the pharmacists we've worked with have always been so helpful. I hope we never have to give up that personal input and go to a mail order type system.

Unknown said...

Hm, no I don't have this kind of problems. We have universal healthcare, plus dental insurance.