Why You Need To Watch Your Medicine


My morning began with a scare, followed by an unnerving wake up call. After a two week-long wait, I still hadn’t received my mail order delivery of insulin. My prescription for insulin, a drug I have to take every day, the very drug upon which my life depends on, sat unnoticed at my mail order pharmacy for two weeks — before promptly getting cancelled.

Three things this experience has taught me
1) You should closely monitor any medicine you order from a direct-mail pharmacy.
2) You cannot assume that any medicine you consume now will be covered by your health insurance company in the near future.
3) For every person on the other end of the phone who don’t seem to care about your medicine order, there are some who do.

June 7th, 10:30 AM: Just a week ago I had received a robo-call informing me that my order was being processed and readied for shipment. So where was it? Confused, I put a call in to my pharmacy.

After much confusion, a phone rep informed me (with all the concern of a baked potato) that the computer screen showed my prescription was awaiting “Prior Authorization” from my doctor. Prior authorization is a form doctors must fill out when a patient’s drug isn’t listed on the health insurance company’s list of covered medicines for that year. The list of approved drugs changes yearly, regardless of if the patient has been successfully consuming something for years. The system had been waiting for it since May 26th, when a call was made to my doctor’s office inquiring about the prescription. Someone had yet to call back.

I immediately put in a call to my doctor’s office to inform them of the pending request for the authorization form. The secretary told me a temp (who had since left the post) had sent in the original script, and no one knew it needed authorization. She left to get the paperwork.

I call my mail order pharmacy back and immediately demanded to speak to a manager. Disappointed, angry, frustrated and hurt, I asked “Why did no one call me to alert me of this hold up? I’ve been waiting two weeks for a drug, I could die without!” He apologized, offering few answers and little help. He simply suggested that I should have my doctor restart the authorization process.

Wanting to make sense of this, and hoping to feel somewhat acknowledged in the process, I called my health insurance company. “How do these things happen?” I implored Sherry, my phone rep. Patiently, she explained the need for prior authorization and how drugs get covered and uncovered every year. It’s clearly all about the money, I reasoned. She could spare me the poorly crafted excuses.

Frustrated, I implored: “I have Type 1 diabetes, I can’t live without insulin. I got a call last week informing me of the shipment, it’s been two weeks and nothing’s been done. How is this possible?” Sherry listened patiently and in a surprising twist of fate quietly informed me that she too had diabetes — she understood, she cared. Apologizing for the company’s mistakes, Sherry vowed to help me, and immediately got to work by sending a prior authorization form to my doctor, even calling to ensure it was properly processed. By the time we hung up the phone I felt not only calmer, but pleasantly amused: I had made a temporary new friend.

At 8:45 the following morning, Sherry called to inform me that the authorization had gone through. She also cleared it so I could get a 30-day supply of insulin from my local pharmacy, as I awaited the mail order script. “I know your doctor’s office opens at 10:30,” she continued, “and I know you don’t want to bother them again, but if they fax a script for a month’s supply of insulin to your local pharmacy, I’ll make sure it doesn’t interfere with getting your 90-day mail order supply.”

Problem solved, and with Sherry on my side, I began to wonder why the problem had even occurred in the first place? Why had the mail order pharmacy not taken notice when two days had gone by and my doctor hadn’t done anything? A week had gone by and they still hadn’t heard from my doctor — why hadn’t anyone called me? How could a doctor’s office not have followed through on an authorization processed two weeks ago? Why were people so uninterested?

All these things point to the typical failures of big businesses, not least of which health care companies. Because not developing a culture where employees take pride and ownership in what they do, doesn’t allow them the authority to make wrong things right.

Was Sherry’s kind gesture merely the product of two diabetics bonding, or the tale of a compassionate individual looking after another? I can’t say, but either scenario kind of sounds like health care insurance to me.

P.S. Sherry called me back two hours later that morning to tell me that since my mail order pharmacy hadn’t gotten the prior authorization form in time they cancelled my prescription!

In full dislosure I did not use the names of my direct mail pharmacy and health insurance provider because I have not asked these companies to comment.

Originally published on Huffington Post.

Notify of
oldest most voted
Inline Feedbacks
View all comments
11 years ago

I just wanted to weigh in…. I have had type one diabetes for 37 years and I also have worked for Insurance companies for the past 28 years. I have watched and experienced the change of culture at businesses over the years and the experiences you have (as well as myself) are not unique to insurance companies. It happens to me all the time with my cable company, phone company, etc…. We also have progressed to more “self service” in business. I also see this with hospital stays of family and friends. I am a nurse as well and many… Read more »

11 years ago

How’s this for health insurance mess-ups: My insurance company let my pharmacy overcharge me in the neighborhood of $500 for my prescriptions because the computer didn’t register that I had already met my deductible.  I finally hear from them six weeks later, when they finally “re-process” a number of other expenses to even things out.

Lesson learned: I’ll be keeping close track of my expenses toward my deductible from now on.

Copyright © 2009-2021 Diabetes Media Foundation, All Rights Reserved.
ASweetLife™ is a trademark of the Diabetes Media Foundation, All Rights Reserved.
Would love your thoughts, please comment.x