I HATE INSURANCE COMPANIES!!!

The level to which I HATE insurance companies cannot be described at this moment.

United Health Care's Medicare Part D prescription plan is as big a scam as their HMO healthcare coverage. I almost died many years ago from a United Healthcare HMO doctor refusing me access to specialists. We dumped their coverage immediately after that, and paid for the good coverage ever since.

Now, UHC Medicare Plan D is trying to force John off a needed medication and onto a MUCH cheaper one. Only problem??? The NUMBER ONE (#1) CONTRA-INDICATION FOR THIS MEDICATION?????? CANCER!!!!!

They have resorted to an entire collection of lies to make this happen. We did not know until dinner time on Monday that this drug requires prior authorization. The NICE lady at the UHC phone line told me that, told me how to begin the prior authorization request, and WARNED me that they would probably try to force John onto the cheaper pills.
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Tuesday at 2 o'clock I called the number for John's doctor, but I called the wrong office- he sees patients at Moffitt, but also sees non-cancer patients across the street at the USF medical center. The nurse manager at USF made notes for the doctor about my call, then called the nurse manager at Moffitt to bring her up to speed.

Yesterday, Wednesday, John got a call from UHC that his medication was being denied and he would have to switch to the cheap one. He called originally, but they got him both confused and upset because they "didn't know anything" about my phone call Monday. So he put me on the phone.

The first LIE was that he was being denied because of the doctor's failure to respond in a timely manner. She then stated that it had been more than 72 hours since they had submitted a request to our doctor and he had ignored it. Well, this was me going nuclear time #1. Oh, they submitted a request more than 72 hours ago?? How did they do that when the request process had only been initiated 48 hours ago, and oh, btw, did they really submit claims over the weekend? Because that was when more than 72 hours was. Then she claimed that their rules were "72 hours or LESS"!!!! That one really got me going. 72 HOURS OR LESS???? Could that mean they could make it , say, TWO HOURS IF THEY LIKED?????

So, my loud and sarcastic and "that voice" (my kids call it the "stupid salesperson voice") resulted in a complete change of course.

Now, John's Doctor HAD called in. And.... he had refused/been unable to answer any of their questions!!!! He had said "I DONT KNOW", or "I DONT HAVE THAT INFORMATION" TO EVERY QUESTION THEY ASKED ABOUT JOHN!!!! So, NOW the reason for the denial was the doctor's refusal to cooperate, or his incompetence. As you can imagine....AT THAT POINT I STARTED YELLING!!!

I demanded to speak to a supervisor, and the young chit refused saying "THEY WILL ONLY TELL YOU THE SAME THING"!!!!! She finally caved after one of the better dressing downs of my life.

At first the supervisor tried the same thing, and I proceeded to explain that she was slandering the head of a major research team at one of the leading hospitals in the country and I would be notifying him and the hospital of that fact. She suddenly thought that it was unlikely that he had really said those things, but mysteriously, the person who had (supposedly) entered that information had neglected to sign off, so there was "no way" she could determine who had made such a mistake. Yeah, "mistake"- keep calling it that.

She went all nice and helpful then. Told me she was going to send another fax request for the authorization form. Told me she was going to send it keyed as urgent. I asked what that meant- and forced her to admit that "urgent" meant that IF THE DOCTOR DIDNT COMPLETE AND RETURN THE FORM IN 22 HOURS- YES, THAT IS TWENTY TWO HOURS!!!!!!- they would AUTOMATICALLY reject it!!! I explained, as if I was talking to a VERY stupid 4yo, that his doctor saw patients in 3 separate offices and John's records were only at one of those offices, and that I had no idea which day the doctor was at which office, until she finally agreed to send it keyed "standard" which gave the doctor 14 days. Then I checked on where she was sending it, and she was, of course, sending it to the wrong office. She "didn't know" that Tampa General in South Tampa was "different" from the Moffitt Cancer Center. Yeah, right!!!!!

So we got off the phone, after almost an hour, with her promising total cooperation.

Today I called the nurse manager at the Moffitt office. Did she get a fax or email request for a prior authorization for John's medication?

I shall leave you to guess the answer while I begin to work my way up the chain on the phone with UHC. Oh, and while I find the correct person to read the above. Do you think they will be happy to hear from me?


Teresa

Happy Mother's Day!!

It has been a lovely Mother's Day. We went to Roy's Tampa for Brunch and it was delightful. Roy's may be my favorite restaurant ever. We've been to Roy's Waikiki each time we've been to Honolulu and enjoyed it immensely. 

Today we had a tasty treat that i can't remember the name of, but its kind of like a sweet hush puppy, and comes with 3 dipping sauces, one chocolate, one like the cream in an eclair, and one strawberry. For appetizers we both chose the lobster bisque, which is savory rather than sweet like usual, and really good. We both also ordered almost the same entrees- he had Roy's Benedict with filet mignon and I had the crab cakes version. Both were terrific, although we neither of us loved the cheddar-bacon biscuits. John finished all of his- I only managed one of the two crab cakes, so we know what John will have for lunch tomorrow, if it lasts that long.

We took the very long way home, all streets and back roads, no highway, and enjoyed seeing parts of Hillsborough and Pacso counties we had never seen before. Fortunately, John really enjoys driving and I love riding and looking around, so just one more way we are a good match.

All in all, a lovely day!