"Transition In Coverage" Was Transition To Insurance Hell For Seizure Patient Running Out Of Pills

I recently had a change in health benefits and Pacificare was the provider. I am using the corporate names because it is unconscionable what they have done and I do not wish to protect the guilty. To be brief my wife suffered a stroke 3 years ago and takes seizure medication 5 times daily. Our transition in coverage was changing from being on my employer’s plan to Cobra, no benefits were changing! My wife happened to have only a 1 day supply of medication when we were making this transition. We told the benefits administrator and they said we could overnight the paperwork and payment to them and they would then send the information to Pacificare marked “rush,” which in this case seems to mean mark it rush so you feel better but we don’t care we have a process…

We contacted Pacificare and explained my wife’s situation, the response was not do the right thing, the response was wait 24 hours. Obviously we couldn’t wait so we called the Rite Aid pharmacy and explained the benefits were processing, we have been filling the prescription there for 3 years could they give us enough pills to cover through the weekend since 24 hours really meant Monday by now and that was 3 days away. Pharmacy couldn’t make the decision. SO I call Rite Aid corporate get a hold of an executive over the pharmacies and they promptly proceed to contact regional managers and drive it down through the food chain to give us medication until Monday. Now I think everything will be fine because by Monday they will process everything. BOY was I wrong.

Monday morning my wife is out of pills. We contact Pacificare to verify everything has gone through, answer is no, they have me but not my wife on our benefits. Now there is an error on their side. My wife is instructed by Pacificare to call another company, Prescription Solutions, who apparently Pacificare is contracted with. They tell us we need to call Pacificare that it will take 24 hours once Pacificare send them the info. At this point my wife comes in and is in tears having a breakdown. For a week she has been stressed out trying to get her medication fighting with everyone every day. (I will be contacting my attorney to see if there is any case here)

So now I call Pacificare. I tell the CSR that I need help with 2 issues. The first issue is how to get my wife her medication today and the second to identify who I might speak with at Pacificare to share my experience over the past week. The CSR then tells me she is the one who spoke to my wife and told her to call Prescription Solutions. I’m thinking great she will help us, wrong! She proceeds to now tell me to call Administaff, the benefits administrator, who, by the way, has been the only helpful group in the process. I then ask the CSR if I could speak with a supervisor. I quickly get a reply. NO. I can have a supervisor call you in 24 to 48 business hours. I just told you I need medication in 3 hours!!! SO I then ask, who does your supervisor report to? Reply: I don’t know! Do you have a phone number for your corporate headquarters? Reply: NO. What do you mean NO? Reply: Why do you need that, sir? So I tell her I need to get to a decision maker. Reply: you can’t talk to anyone, I can have someone call you in 24 to 48 hours. Yeah, I know ,you already told me, you are a robot and don’t think. Please transfer my call to the customer satisfaction survey that the system asked me if I wanted to take. She then promptly drops my call.

Now I’m livid. I call Administaff get the operator and politely ask for the most senior executive I can speak with in the company. You know what she does? Transfers me immediately to the CEO’s office. Now while I’m impressed it still shows that Administaff has been the only company with alignment of a service culture as they have tried to help me from day one.

I am going to start a new blog dealing with this kind of stuff. Can you help bring this example of a horrific experience to a broad audience?

- Michael

Seth Godin forwarded this one to us from one of his readers.

We don’t know much about insurance, but we do know that if you tell people with only a day supply left that you’re rushing their medicine, you better damn well do it.

(Photo: tmq666)

Comments

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  1. Jaysyn was banned for: http://consumerist.com/5032912/the-subprime-meltdown-will-be-nothing-compared-to-the-prime-meltdown#c7042646 says:

    Insurance is such a horrible scam.

  2. superlayne says:

    Holy hell. My grandfather had a stroke, and if he wasn’t able to get his medicine because of bs like this, my grandmother would be livid. When you’re in charge of the medical funds for someone with a serious condition, you don’t give them 24-48 hours. A single seizure can kill and disfigure in seconds.

    Administaff? I’ve never heard of them before.


    If I had been in that situation? ooooh, I would have tried to wring that CSR’s neck. Apparently, “My wife needs her seizure medicine in 3 hours,” doesn’t translate well into stupid.

  3. dbeahn says:

    This is what happens when you have to call Bombay or New Delhi to speak with someone who “Is very much thinking they would be liking to helping you!”

  4. Lewis says:

    Here’s a situation that is just heartbreaking. I don’t know the specifics of the complainant’s financial situation, but as the goal was to get this woman her meds, perhaps an emergency credit line increase on one of their credit cards would have been a good call to make?

    I hope this situation resolves itself.

  5. RoCJester says:

    This totally screams one thing to me, Lawsuit maybe?

  6. Elsewhere says:

    Having just escaped from the Hell that is PacifiCare, I sympathize; PacifiCare seems to be the insurance of last resort for companies that must provide health insurance to employees. They’re cheap on the bid for the business, but there’s a damn good reason they’re the cheapest. Everything to do with administering PacifiCare from the HR standpoint is a nightmare, and their customer service is non-existant.

    My guess is that “Administaff” is an outsourced benefits management company; you mentioned that coverage is under COBRA, so it sounds likely that Administaff is the company contracted by your former employer (not by PacifiCare) to handle all COBRA-related administrative duties. Administaff can be as nice to you as they want to be; they cannot actually make the insurance company do anything, like process your coverage. Their job is to navigate the federal requirements of COBRA for your former employer.

    I would suggest contacting your states Department of Labor (they can be very interested in COBRA issues, and in my experience — at least in CA — their attorneys can be real pit bulls) and your states insurance regulatory commission.

    Meanwhile, I can only wish you the best of luck. For the rest of us, don’t worry; our turn in health care insurance hell is coming… that is, if you can get health care insurance at all.

  7. nikkilove says:

    As someone who also suffers from a chronic condition, they should have simply purchased the medication, and then sought reimbursement from the insurance company. I know how expensive meds are, but Costco and Wal-Mart are considerably less expensive. And if money is that tight, another commenter posted that credit card companies do offer emergency credit increases. That all said, it really is a damn shame. Sicko here we come!

  8. sonichghog says:

    They really screwed up here. They need to get the coverage on.

    Just an FYI, you should not let any medication that you have to take to live, go down to a 1 day supply.

  9. MommaJ says:

    I do feel for these people, but anyone who takes critical medication on a regular basis (two in my family) knows that you have to act defensively–never let yourself get down to one day’s supply, always have cash on hand in case of an insurance foul up. I don’t know how much one week’s supply of meds would have cost this woman, but unlikely more than $100, and she could have submitted an claim for at least part of it once the coverage was in place. Yup, the pharmacy will always take cash. Snafus occur all the time, customer service stinks, and we all need to plan ahead and act intelligently to avoid crisis situations, which is a lot more useful than starting a blog.

  10. Feels like a snafu on the insurance company’s side of things, but I don’t see lawsuit material. Was it a bad situation to be in? Yes. On the same tip, though, there is always a work-around for getting necessary medication. If you go to an ER and explain your situation they’ll usually get you setup with at least a 3-day supply to get you by. Like others suggested, there is always paying cash out of pocket. Every time I’ve needed to, I’ve been able to literally pay per dosage and just let the pharmacy know how many days I needed it for. Convenient? Not really. But it saved my ass more than once.
    I think the proper approach on this would have been getting the medication through other routes and battling this battle at less of a medical-emergency time.

  11. pinkbunnyslippers says:

    While Administaff typically does pure “benefits administration” for companies, it more often takes care of all HR related activities for a company. Hence, this guy is in theory employed by Administaff. I’ve worked for 2 different companies who used them, and this is how it worked.

    So in essence, Administaff can definitely put some pressure on the company, but I wouldn’t hold my breath.

    While this is a terrible ordeal that I wish this poor man and his wife didn’t have to be going through right now, this may very well serve as a valuable lesson to anyone who is on life-sustaining medications that you need to have backups and contingency plans in place. If this had been a natural disaster, I’m saddened to say they would have nobody to blame but themselves, which is why I think a lawsuit won’t hold up much.

  12. bnet41 says:

    Just curious here, why did they not purchase the meds with cash? I don’t know how much these medications are, but it could be one of those that are crazy expensive. Maybe that’s the issue, who knows.

  13. pinkbunnyslippers says:

    I just posted this comment, but somehow the site ate it. So forgive me if it shows up twice.

    The basis of my comment was Administaff is technically this man’s employer, and not simply a “benefits administrator”. Therefore, they most definitely have some clout to hold in dealing with the insurance company. Either way though, I wouldn’t hold my breath.

    I also think that while this is a sad sad occurrence and I really do feel for this man and his wife, I think it serves as a valuable lesson to anyone on life-sustaining medication that there needs to be backup measures and contingency plans in place. Had this been something like a natural disaster and weren’t able to get meds because of lack of open pharmacies, etc., I’m saddened to say they would have nobody else to blame but themselves.

  14. pinkbunnyslippers says:

    I just posted this comment, but somehow the site ate it. So forgive me if it shows up twice.

    The basis of my comment was Administaff is technically this man’s employer, and not simply a “benefits administrator”. Therefore, they most definitely have some clout to hold in dealing with the insurance company. Either way though, I wouldn’t hold my breath.

    I also think that while this is a sad sad occurrence and I really do feel for this man and his wife, I think it serves as a valuable lesson to anyone on life-sustaining medication that there needs to be backup measures and contingency plans in place. Had this been something like a natural disaster and weren’t able to get meds because of lack of open pharmacies, etc., I’m saddened to say they would have nobody else to blame but themselves.

  15. gibbersome says:

    I’ve had a much worse experience with Humana. They denied my aunt coverage for a bone marrow transplant for blood cancer since she failed to mention that she worked as a lab tech for 3 months 10 years ago on her application form. In the end, it didn’t matter but seriously, what in the world in going on with healthcare in this country? Best bet is stay healthy.

  16. drusse11 says:

    Being that I work at one of the major pharmacy’s in America I can honestly say that this gentlemen deserves all of the hassle that he received since he went about this process doing almost everything completely wrong. His first mistake would be switching to Cobra. Not the best insurance you can have to say the least. Second Mistake. Why would switch insurance companies when you only have a one day supply of vital medication left.? He could have used a little foresight and said “hey there might be a problem when I switch insurances, why don’t I pick up my wife’s prescription a few days early so she does not run out of the medication she needs.” Since almost every insurance companies allows refills a few days early this certainly would not have been hard to do and would have solved all of his problems.

    Third Mistake. Why would you get angry at the pharmacy that you use. They have absolutely nothing to do with your insurance company and since they are not your insurance company the only solution that they can offer is to fill the prescription for you and then have you pay full price for the script. I understand that the prescription could possible be hundreds of dollars but there are also solutions to that problem. The first option would be to only fill a few days supply at a time for you. Depending on whether or not the drug is controlled that process would be quick and painless. Another option would be to have the pharmacy fill the full script for you and then once you sort out the problems with your insurance company the pharmacy could then re-submit the prescription and refund you the appropriate amount of money. If the pharmacy did not offer this gentlemen these option well then he does have the right be upset with them.

    Fourth Mistake (a personal opinion here) Don’t become irate when trying to solve a problem. That will never result in anything good. After reading similar thoughts many, many times on this website I think that almost everyone reading this could agree to that.

    Finally I just want to say that I do not want to come off sounding like a jackass who doesn’t care that this man’s wife was having problems getting the medication that she needs. I honestly do care and almost every day I am able to successfully deal with situations exactly like this. All it takes is a little patients and understanding for the customer.

  17. HannahBethD says:

    The last time I was on daily, had to have it medication and knew I would insurance might pose a problem, I called my doctor and she gave me some sample packs to carry me through the week or so.

    Granted doctors offices probably don’t keep sample packs of every medication they prescribe, but could it have hurt to ask her doctor?

  18. rockergal says:

    i dono, instead of having the wife have a nervous breakdown, he should have just bought the meds. i mean really anti seizure meds???? I would have gotten the cash or credit card out immediately in this situation. better trying to get your money back then have the wife have a seizure

  19. lindsaynagle says:

    I feel so horrible for these people. I would have also suggested they pay out of pocket for the medication and submit their claims for reimbursement. But that is having no idea what this medication costs. The wife needs to take 5 pills a day – what if these pills are $20 a piece, or more? I’m taking a medication for morning sickness that is $26 per pill. My health insurance covers 20 pills a month. I need two per day. So I am paying some crazy ass money on a weekly basis to be able to stop vomiting long enough to get to my job. Luckily, it’s not a permanent condition. If I were this woman’s husband, I’d be on a bus to Canada with my that prescription.

  20. nightbird says:

    As with most of you guys, I sympathize with this guys story. Unfortunately, his isn’t anything special to write home about.

    I spend roughly 3/4 of my day doing nothing but insurance company drug authorizations. I’m probably the closest your going to find to someone that understands how the system works, aside from someone at the insurance company (and that isn’t always a guarantee)

    His first mistake was to hope that the problem would be resolved quickly. Nothing happens quickly when it comes to insurance. His was great with being on the ball and calling people to get it resolved, but until insurance came through, he should have been calling his wife’s doctor. Most office’s keep samples on had that they will give to any patient that asks (within reason). If for some reason they didn’t have any on had, they could have called the sales rep for that drug, who would have been able to get some.

    On the larger topic of presciption drug insurance, it’s a mess. Commerical plans given by the normal employer are mostly useless, in that you cannot rely on them to have any interest in your health. It’s all about cost and profit to them. I work in a specialty clinic, and have to argue with companies over payment, and have had necessary medications denied due to cost.

    Medicare D was a good plan in concept, but implementation the ball was dropped. Farming management out to the insurance companies, rather than keeping it governmental, was a BAD idea. The only seniors that really benefit from D are those that are “with it” and computer savvy. Those that aren’t get tossed into any old plan, and they wind up spending more than they had before the switch.

    Sigh, I could go on for a while about this and do my own little “confessions” post, but I must get back to work getting people their medications.

  21. juri squared says:

    I agree that in the future, if at all possible, stock up on as much medication as your insurance will allow before the switch occurs.

    Begging samples off the doctor generally works as well; the larger and older the practice, the more likely they’ll have what you need thanks to the bazillions of drug reps.

    My insurance switched while I was in the hospital giving birth, so that I was covered under one plan and our baby under another. Surprisingly enough, this has not been the complete nightmare I was expecting it to be. It’s mostly round after round of phone tag with the doctor/surgeon/anesthesiologist/lab/hospital/whoever else sends us a damned bill and updating the insurance information.

  22. BII says:

    Suggesting emergency lines of credit, etc, etc, while all helpful, really point out how ludicrous our health system really is.

    Insurance companies have no incentive to work hard to get patients the service they need, as they already got paid. What kind of health care system is that?

    We really do need single payer.

  23. nightbird says:

    To address the cost of medication, if it a brand name, newer drug I can almost guarantee that it will be expensive.

    Viagara, last time I checked, was about $10 a pill.

  24. TinaT says:

    My pregnant sister needs a shot once a week to keep her from going into labor prematurely. The shots cost $100 a month. The insurance company doesn’t cover it. A single day in neonatal intensive care for a premature baby costs more than the entire course of shots.

    They are still appealing the decision, but in the meantime, paying for it out of pocket.

  25. Red_Eye says:

    @Michael
    If youre serious and need a server let me know. I’ll put you up free with enough space/bandwidth to run a good blog. Just email me at tempresponse55@pcsites.com

  26. tallladude says:

    Perhaps I’m missing some facts here, but I’ve been in a similar situation and it seems the submitter has shifted made a huge ordeal out of a problem that really isn’t the critical nature for which the complaint was made.

    The critical issue was the need for the submitter to refill his wife’s anti-seizure medication, which is certainly an understandable concern. But the submitter made the issue “refill the wife’s prescription with immediate insurance coverage”. He implied that having Rite-Aid refill his prescription was conditional on having his prescription drug coverage go through. That is simply not the case. If a person has a valid prescription, they always have the option to the cash price. (Now if his wife didn’t have any refills, then the issue would have been between her and her doctor, and that certainly wouldn’t have had anything to do with Pacificare.)

    The prices for the most prescribed anti-seizure medications are as follows:
    Dilatin 100mg &nbsp   &nbsp &nbsp 90 caps &nbsp $18(gen)/$35(brand)
    Tegretol 100mg &nbsp &nbsp 60 caps    $13(gen)/$25(brand)
    Topamax 50mg      60 caps    $250(brand)
    Klonopin 1mg  &nbsp &nbsp &nbsp  90 tabs  &nbsp $30(gen)/$120(brand)
    Keppra 500mg &nbsp &nbsp    30 tabs &nbsp  $85(brand)

    With the exception of Topamax, most of them really aren’t priced so high that the average person wouldn’t be able to afford paying the cash price upfront. If the submitter is able to afford COBRA rates, then this certainly shouldn’t be an extreme burden. And as I indicated, I don’t know all the facts, so perhaps the drug in question might be some experimental medication that runs $1000 for a 30 day supply. Maybe I’d buy into seeing a true problem here if that was the case.

    So, the submitter is faulting the insurance company, Pacificare, for this entire problem. The only thing I could possibly fault them for is not apprising him of his options for delayed reimbursement. It’s quite possible however, that as the insurance company, they may not have been the party that covered prescription drugs. At my last employer, I had my insurance coverage from UnitedHealthcare, but prescriptions were self-insured by my employer and administered through Merck-Medco. I’m sure many people don’t recognize the distinction. Transitioning from insurance coverage as an employee to coverage under COBRA can involve a handful of entities. The employer may have a third party firm administer benefits. They deal with an insurance company, and sometimes prescription coverage is handled by a separate company. Generally, the insurance company bills the employer for all its covered employees. When it comes to separated employees, they may use yet another third party firm to process payments for COBRA coverage. The net result is, it can take some time for all these entities to get the word once you’re separated with your employer, that you are electing to continue your benefits with COBRA. But it’s really not a big deal. Federal law specifies you have 60 days following your separation date to elect coverage. If you do, it goes back retroactively to the point at which your employer coverage ended. Any expenses you had to pay the full price out of pocket can be submitted for reimbursement.

    Worst case scenario should have been, the submitter would have had to fork over the full cash price to get his wife’s refill. Once coverage was re-established under COBRA, he could take his receipt back to Rite-Aid, and they would have resubmitted the claim and refunded him the difference between the full price and his copay. Had he put it on his credit card, he likely could have gotten a credit before his bill became due. I’ve been through this very situation with Rite-Aid. It’s a little bit of a pain to return to get the claim reprocessed, but doesn’t come close to the critical situation the submitter based his complaint on that he was prevented from getting a refill of his wife’s medication.

    If there’s any blame to place here, I’d put it on Rite-Aid for not explaining to the submitter he had such an option. I don’t want to speculate too much here, but if the submitter expressed the degree of anger he imparted in his complaint to the pharmacy clerk at Rite-Aid who likely makes just $8.50/hr, even if that person had known, they likely may not have had much of an opportunity to explain the options.

    This forum is a great place for us consumers to share legitimate complaints we have with others out there who might have similar problems. I think its important that we need to be educated consumers, and that if a process doesn’t happen the way we want it to work, that doesn’t in and of itself automatically deem it to be a legitimate complaint.

  27. Mom2Talavera says:

    The only way to kinda beat the system is to never get sick in the first place. Its cheaper to live healthy and stay well than it is it get sick and try to get well again. Genetics aside alot of people wouldn’t develop some of the conditions they have if they didn’t live on a steady diet of cholesterol and saturated fat-laden fast food ;chicken nuggets, burgars…refined grains-bread, pasta, doughnuts, chips, meals-in-a-box, muffins, crackers…soda…frozen meals…Kraft crap & cheese…ect

    You can’t put any more types of meat on a bacon-cheesburger.
    Once you’ve made it a bacon-cheeseburger, you’re done. If you’re adding more than that, you have to opt out of Medicare.

  28. Enola #### says:

    @tallladude: Perhaps paying for the COBRA coverage rendered them unable to pay out-of-pocket costs for prescription drugs. We recently paid $700/month for COBRA when my husband switched jobs (until his new company’s insurance kicked in) and we would not have been able to pay for most of my medications at out-of-pocket prices during that time, even those that were $50 or $60.

    I think the advice to get credit to cover such emergencies is terrific, as is asking your doctor for samples. My doctors understood my financial situation when we were paying for COBRA coverage and several of them provided me with samples during that time.

  29. @gibbersome: “what in the world in going on with healthcare in this country?”

    insurers have been restricted by law from denying or restricting benefits below a certain levels, so the new game is to deny coverage completely for “errors” on the intake forms. They’re for-profit and they can’t make money if they have to pay for patient care.

  30. Seth_Went_to_the_Bank says:

    I think some people posting here are having a hard time realizing what it is probably like in the patient’s shoes.

    Medical problems often beget financial problems, which beget more problems. Having gone through many medical and insurance problems myself, I can tell you that even if you are very well educated and always do the “right thing” – fill out the paperwork promptly, stay informed, get samples from your doctor, have a good relationship with a pharmacist…

    There are still times when you are really screwed, so to speak. I’ve been there.

    And the insurance companies DO make mistakes and the problem is that YOU are expected to fix them, whether you are a healthy adult or whether you are suffering from an extremely serious illness.

    And doing the job of the insurance companies can sometimes be an almost a full-time job in of itself. I have sat on the phone reading from my insurer’s own materials explaining – sometimes patiently, sometimes not so patiently – their own policies and procedures to customer representatives who have been given neither the training nor authority to help patients.

    So just consider before you apply your own experiences to this couple’s situation that we really don’t know what they’ve been through…

  31. aujahlisa says:

    @ DRUSSE11:
    “His first mistake would be switching to Cobra”.
    I do not feel that there is a a mistake there. COBRA coverage is federally obliged to be the same coverage that the insured had while an employee. I realize (oh boy, have I been there…) that reality isn’t quite the same as “obliged to…”, but a person is offered the option COBRA when they separate from their job. The only “choices” are to pay the full premium to maintain coverage or to risk going naked – which in this case would be terrifying and terrifyingly expensive.

    I have been on COBRA – did my chemo while on COBRA, and the coverage was identical to what it had been before I was laid off. I also “ran naked” for 2-and-a-half years because later I lost other COBRA coverage. I was lucky. I am still in remission (+5 years!) but not knowing, and not being able to afford to verify is horrendously stressful.

  32. chickymama says:

    ( i pressed enter by mistake)

    The first line on his story stated that he had a change in health benefits which is misleading. His benefits didn’t change, the elgibility did.
    Believe I deal with these type of issues everyday as I work in medical billing a major hospital here. And yes, Pacificare is an awful insurance to work with.

  33. pinkbunnyslippers says:

    @Mom2Talavera

    Um, no offense, but that is the worst argument on this entire thread. “Don’t get sick”, first of all, isn’t as easy as you seem to think it is. And furthermore, I can bet my @$$ that this woman isn’t having seizures because of her “steady diet of cholesterol.” Get off your high horse please.

    People have medical conditions for reasons OTHER than what they eat, just FYI.

  34. LAGirl says:

    i get terrible migraines. they can put me in bed for a few days, or worse, send me to the ER. when i feel a migraine coming on, i take Relpax. if i take it in time, it usually prevents the migraine from coming on, or at least from coming on full force.

    last december, Blue Cross decided to lower the monthly quantity allowed by 3. my doctor sent in a prior authorization to increase my monthly quantity and make sure that i don’t run out each month. after some back and forth b.s., it was eventually approved.

    so which costs more? a few extra pills each month, or, a trip to the emergency room? honestly, some of the decisions the insurance companies make are just stupid.

  35. RebekahSue says:

    @tallladude:

    Dilatin 100mg 90 caps $18(gen)/$35(brand)
    Tegretol 100mg 60 caps $13(gen)/$25(brand)
    Topamax 50mg 60 caps $250(brand)
    Klonopin 1mg 90 tabs $30(gen)/$120(brand)
    Keppra 500mg 30 tabs $85(brand)

    I just wanted to comment to the people who suggested that the family purchase out of pocket. I take a seizure medication that can also be used for pain. It’s not in this list. Before it went generic, it was $520, I think, for a month supply; generic is about $250 (without insurance). My dosage is probably lower than this lady’s, since I don’t have seizures.

    The article doesn’t say, but the OP’s letter mentions COBRA. He may be out of work, or he may have started a new job whose benefits haven’t started yet. COBRA, for those who’ve never needed it, is the full price of the health insurance, and not the $20 or whatever per paycheck that a person pays within his job. If the OP is between jobs, there’s no way he’ll be able to afford to pay cost for medication, even if he does have credit cards that he can max for a high percentage. (However, if he’s not reimbursed, and he can pay cash, the cost – just like copays – is a medical expense that can be written off their annual income tax if they itemize. My copays exceed $1200 annually, so I itemize and write them off.)

    The pharmacy MAY be able to sell it to them by the day or week.

    I’d also suggest contacting the wife’s physician’s office; the doctor may have samples, or a contact to buy directly from the pharmaceutical company for less. (A-Z is one company that offers this option, and there are a few others.)

    I hope – and doubt – that Pacificare will give the family credit for the time the wife wasn’t properly covered.

  36. Bulldog9908 says:

    What happened to personal responsibility?

    You let a critical medication get down to a day’s supply when you clearly knew in advance there would likely be problems changing to COBRA. Get your medication before the switch so you’ll have a week, or a month, or however long it takes to get the insurance switched.

    Yeah, insurance companies suck, but everyone knows that. Plan for it.
    ———————–
    To those of you suggesting single-payer systems, I invite you to go to Canada, or the UK or Cuba and try to get some critical test or treatment in a timely manner. If this were Canada, his story would be complaining about waiting 90 days to see the doctor to prescribe the medication in the first place. You think three days is bad? And you want to bring that system here and let the government care for you? Yeah, that would actually be worse than what we have now.

    …Not suggesting we don’t need change, just suggesting that replacing a bunch of big bureaucracies that are bad at doing things with a giant bureaucracy that fails at everything might not be the best solution.

  37. Seth_Went_to_the_Bank says:


    What happened to personal responsibility?


    This is just code for “someone has to be blamed” “don’t look at me” and “fuck you.”

    There are a lot of situations in life where there is no one to blame. This is a hard concept for some people to get. There are things you can’t plan for. And when you see someone suffering, someone in Katrina on top of their house screaming to be rescued or someone saying I can’t get my medication my wife is having seizures or some kid in Iraq who doesn’t have enough to food to eat – you feel panic. You feel you have no control and you lash out!

    Someone has to be to blame for this… and it isn’t me. So it must be you. You resent that person for bringing you those feelings and then you blame them for it.

    You’re really just blaming them for your own personal discomfort and your own feeling of helplessness. You don’t know anything about these people and you’re in no position to judge anything. None of us are.

  38. ingridc says:

    @Drusse11: Dunno how you expect to not sound like a jackass when you say that the guy “deserves all of the hassle that he received since he went about this process doing almost everything completely wrong”. Most people who are on chronic-condition meds and who don’t work for insurance companies don’t know exactly how to go about this process doing everything “right”. My mom has been on similar meds for over 10 years and she still doesn’t have it all down.

    And unless I missed something, I don’t think that your “third mistake” was true; he didn’t seem “angry” at Rite-Aid as much as he was just laying out all the steps he had to take to get enough pills for the weekend. It’s frustrating to have a history with a pharmacy, knowing that the pills are right behind the counter, and you still have to cut through plenty of red tape to get a couple of days’ worth. It was complicated and worth mentioning for the bigger picture.

    While it is kind of a “duh” that he should have gotten a refill before he switched insurance, I don’t think he did anything “wrong” in trying to navigate our complicated and effed-up insurance system in a dire situation. Kudos to the other helpful suggestions (credit, cash, doctor’s samples). I’ve had to pay cash a couple of times, and though it hurt (350 bucks! Ouch!), I was always reimbursed.

    @Nightbird: CONFE-SSION! CONFE-SSION! :D

    Can’t wait to see “Sicko”…

  39. flackman says:

    I really empathize with the author of this post. However, I feel obligated to offer some advice to those who may find themselves dangerously close to this situation.

    1) Most economists advise having a 3 month salary “buffer”. Considering a stroke, the buffer may easily be eaten up in a matter of days. Allowing a necessary prescription lapse even to week’s supply would put me in a very bad state of paranoia.

    2) As stated above, necessary meds will be supplied at any ER.

    3) CORBA. Smells and tastes like cobra. Sorry, anal.

    Bottom line is, OP needs to be in touch with a “decider”. None were provided. I wonder if, at some point, the CS rep on the line pointed to your meds on the chart and figured it was not a matter of life and death? Seems any healthcare provider would have that chart available to their phone-monkeys. Consumerist undercover op anybody?

    So now what? Does Pacificare put the trouble on the local ER to deal with if your wife had a seizure? Do they pay for that? Or does that mean they didn’t think OP’s wife would have a seizure? Did they look at some chart to determine this? I am not a doctor, not even an interweb doctor. The answer to the question (from a real accredited doctor) seems warranted.

    To be redundant and shamefully honest, USA health care is 100% based on what you pay in your premiums. Getting stuck with a bargain provider sucks ass. To be honest, I would not subject my wife to this provider’s service if she needed it. Nor should you, gentle reader.


    Regarding Michael Moore’s latest: You can always find “Sicko” if you look in enough tubes, however I recommend “Dan Rather Reports” on HDNet as it’s really how investigative journalism should be… non-sensationalist and not ridiculously pro-canadian. Nothing against our moose rider friends or Mr. Moore. I believe this is his best film to date.

    In the UK, you may pay for your health care if you do not want to be subject to public health care. Not so in Canada. It’s not by coincidence MM interviews a Briton instead of one of our friends to the North.

    For the record, I support private health care. I am not in a position yet where I could afford private health care if public health care were an option in the USA, but I like the idea.

    I also believe every tax paying american (and the infirm, orphans, etc) should have access to public health care. It’s ridiculous that people won’t go to the doctor because [they believe] they cannot afford it.

    Imagine you are hopelessly ill and cannot afford to go to the doctor. Which crimes are you now willing to commit to save yourself or your family?

  40. franksinatra says:

    my wife and i have medications we take on regular basis, a few months ago when we lost our jobs and insurance coverage, we werelucky enough to have a doctor that wrote us a presciption for 90 days worth of meds..it really helped us until i was able to find another job that had a decent healthcare plan.

    if you’re interested in the innerworkings and whatnot of the insurance industry check a great book called “Sick” by Johnathan Cohn. it really opened my eyes to the fact that for the most part the insurance companies try to pull the wool over american’s eyes.

    simply disgusting.

  41. Jiminy Christmas says:

    @drusse11:

    Sorry, but I find this comment a wee bit objectionable:

    His first mistake would be switching to Cobra. Not the best insurance you can have to say the least.

    How so? It’s the same policy he had before, only he’s paying 100% of the premium.

    There are plenty of good reasons for sticking with your old employer’s health plan via Cobra rather and delaying signing up with a new employer. It could be less expensive. I myself had an experience where getting coverage via Cobra, which you would assume would be more expensive, was cheaper than paying the employee share of the coverage my new employer offered. Switch jobs from a large business to a small one and you could possibly see for yourself.

    Also, one can imagine any number of HMO, PPO or whatever plans the new employer offers where his wife’s regular doctor might be out of network. The increased co-pay or co-insurance could easily make the Cobra payment a better deal.

  42. nardo218 says:

    I’m sorry this happened to you, and I’ve had the frustration and fear of getting the run around over a little bottle of pills. However, I think you had more options than you pursued.

    Why did you let your medication run that low? I always ask my doc for refills at least a week in advance. For the meds I send away for through needymeds.org, I allow a month of processing and general bullshit. I’d never trust a doc to get me my meds in anything less than three days.

    I’m sure these meds are expensive, but could you have paid for three or four days(I’d have gotten a week’s worth) out of pocket? Even if it’s $5 a pill, that’s $20. If so, you could have gone to a clinic or your doc’s office and spoken with whoever was available or on call. All you needed was a piece of paper.

  43. Seth_Went_to_the_Bank says:


    “As stated above, necessary meds will be supplied at any ER.”

    False and spoken by people who have clearly never had to test this.

    You can almost always get a prescription in the ER (after waiting 12 hours or so) but there is no guarantee they will have the medication you need. If it’s not life threatening, I don’t even know what the obligation of the ER is.

  44. Mom2Talavera says:

    @pinkbunnyslippers:
    “GENETICTS aside alot of people wouldn’t develop SOME of the conditions they have if they didn’t live…..”

    Pull your head out of your ass!

  45. pinkbunnyslippers says:

    @Mom2Talavera: LOL ok – I’ll pull my head out of my @$$ when you learn to spell “Genetics” properly.

  46. Mom2Talavera says:

    @pinkbunnyslippers:
    So you can’t read, and I can’t spell.
    That still doesn’t negate my point.

  47. pinkbunnyslippers says:

    @Mom2Talavera: Yes yes, I know – Just giving you grief. We’ll call a truce? :)

    And for what it’s worth, I do agree with you on the fact that this country is severely out of bounds with their nutritional habits, and we’d probably be really surprised at what could happen were we to cut out all the bad junk in our diets, but unfortunately that just isn’t going to happen. Also, things like cancer happen not only because of genetics, but because of other carcinogens like alcohol, tabacco, SUNLIGHT for God’s sake. The argument “just don’t get sick” is a lot easier said than done.

  48. @drusse11 & @nightbird: The insurance company fails to do their job but it’s the customer’s fault for not assuming that the first people they talked to weren’t lying to them? How does that even make sense?

  49. VASummer says:

    I’m glad you had good service from Administaff, as I had the opposite experience. Due to a mistake on their part I was not signed up for my insurance plan. Not having been discovered within 30 days, I was on my own. All I got from any level of Administaff was covering their own butts and blaming me for their mistake.