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When the Harassment Plan Doesn’t Work

Kelly Mack recently wrote an article on her techniques to make sure prescriptions and other medical procedures run smoothly through her insurance company. I agree with her article and often execute my own “harassment plan” but, once, it didn’t work. I often recount this story because it is engrained in my memory and it now seems a perfect time to share it here.

New treatment, new medical bill

A long time ago I switched from the Orencia subcutaneous injections to the intravenous infusions. The IV infusion was amazing and, not only that, I had no issues with insurance for many, many months. Yes and yes! I didn’t experience complications with the pre-approval, it was going through the brand’s co-payment program smoothly and I was getting the medication without issue.

Until one day I received a bill for $267. This was just the beginning. By the end of 9 months, I would have spent over $2000 out of pocket for a medication that was (theoretically) fully covered.

Inconsistent information & the run-around

Talking to the insurance company

I first called my insurance provider. They transferred me to billing. “We ok’ed the pre-approval so the medication is covered. Do you have a co-payment plan for it?”

“Yes.”

“Can I have the card information so we can call the Orencia assistance program and make sure they have the right insurance information?” I gave them my “policy” number.

I called again. “Oh yes, we have that information here and the program said they have the right information as well. Your medication should be covered.” Lies.

A second time around with my insurance company

Two weeks later I received another, ANOTHER, not the same, but a second invoice for roughly the same amount. I was on the phone immediately with my insurance company and was told I owed the full amount on both invoices.

“Hold on! I’ve been on this medication for months, why the change all of a sudden???”

“Maybe they were backdated and finally running through” said the insurance company. No, try again.

Cycling through different explanations

I called the assistance program to make sure there was nothing they could do. “It went through your co-pay and everything is fine. It’s on your insurance’s end.”

Everything was certainly not fine. I continued to receive bills for the medication for nine months, and I was on the phone with my insurance every single morning trying to make sense of them all.

“It’s on the co-payment side. There is nothing we can do since all your information is correct and up to date.”

Which soon became “Oh, you don’t want to talk to billing, you need to talk to specialty services” (who sent me back to billing).

Then evolved to “Oh yes, your file is right here, we have been instructed to transfer you to billing.” Ten-minute wait then a click.

And finally “Ah yes, your file is right here. I have been instructed to transfer you immediately.” “Where??” Transfer, click.

My insurance company had officially blackballed me and I knew full well they were hanging up on me every time I called.

Resolving the problem

Small mistake, major consequences

In one last desperate attempt, I called the Orencia assistance program and spoke to this wonderful, lovely lady who said she would look through my file and if I minded staying on the line with her. She looked through the intensive notes and exclaimed “Oh!”

“Oh! What??”

“I just noticed your policy number under the co-payment plan is wrong by one number. The reason it wasn’t going through the assistance program was because we gave your insurance the wrong number. It’s our fault.”

“Does that mean I’m getting all my money back??” I asked, cautiously. At this point, any time anyone found “the answer” it turned into a false lead.

“We only reimburse sixty days after the bill is sent out….”

Good customer service

I don’t know if she was finished talking but I burst out, nearly in tears, “I’ve been on the phone with you and the insurance every day since I got the first bill and nobody could tell me this little detail. How is that possibly fair???”

“Yes, I see that so for you I will back-date all these bills and make sure you get your money back from January on; minus, of course, the monthly co-pay.”

I was floored and had no idea what to say. All I could do was repeat ‘thank you’ over and over again.

Do you have any insurance stories? Let me know in the comments!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Richard Faust moderator
    2 months ago

    Hi Monica. Reading about the last conversation with the copayment-assistance person makes me think of the dichotomy of emotions they force one through. You feel very thankful to the person fixing the problem, but also left questioning “why am I so thankful for one of these companies finally doing their job right?” They really do leave customers sometimes thanking their tormentors. Best, Richard (RheumatoidArthritis.net Team)

  • Lawrence 'rick' Phillips
    2 months ago

    Oh my experience is about the same today. I have a bill for charges in December for a supply paid for each quarter last year until the 4th quarter. Then they did not pay for the first quarter this year.

    Same company different divisions, so I have to call them twice, have the same discussion twice and get the same explanation. This is not covered. Well what changed? One thing I have discovered has changed. I no longer have the 7 hours I have spent over the last two days. talking to insurance providers. I say providers because it is two both named the same. Go figure.

  • Monica Y. Sengupta moderator author
    2 months ago

    Yikes!! I am sorry about that, Rick.

    So there is no resolution on it at all?

    I agree, I’ll never get those days (probably added up to a full month) back but at the very least, I did get my money back.

    Can your doctor’s office do anything to help?
    ~Monica

  • Lawrence 'rick' Phillips
    2 months ago

    Oh Monica, I have not yet begun to fight. No question this will get paid. Now how long it will take, well that might be something else. But it will get paid.

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