Poor guy. All I can do is feel bad about his situation.

Unfortunately, when there's a problem between an insurer and a provider, it is usually up to the customer to sort it out - very aggravating. It sounds like Chris will be getting his meds soon, which is good...

I hate when you have to know more about billing and procedures than the people who are paid to know about that stuff. I went through the same sort of thing with my doctor's office after surgery. I had to be the middle man between my insurance company and the nitwit in my doctor's billing office and tell them exactly what ICD9 codes to bill it under to get it paid. Why is it my job to tell her how to do her job? Why?

I feel for the guy. Hope he gets it straightened out soon.

Who actually thought that this was anything BUT a CVS screw up? These people have way too much control over life and death for anyone to feel comfortable.

@VA_White:

I agree with you. Luckily my wife works in the medical field and I make her handle the insurance stuff. I handle everything else that's the deal.

Fortunately we haven't had anything that didn't get resolved right away.

For some reason I don't think he's LOLling about this. I wonder why he put that in there?

Any chance he can simply transfer the prescription to someone competent?

I feel terrible for this guy, but I give him big kudos for doing the smart thing and not taking it at face value...asking for information and verification is important, even if it is the only recourse in some situations. I hope it works out in his favor!

@JPropaganda: I think, in this case, it means "Lord, oh, Lord".

@Liam Kinkaid: Look out, Lawsuit!

I use CVS's Caremark.com for all of my kidney meds(Including Prograf) and never had a problem. But then I have Blue Cross Blue Shield.

Oh also he should only owe $60 which is 20% of 300.

Can't they send the NJPAAD to collections? Perhaps take them to small claims court?

@kewl132: no, that ~$300 is 20% of the total cost.

@hillsrovey: It's a little absurd for CVS to not tell him anything about the situation for two whole years. It's nice they were willing to eat the cost for two years, but had they told him 24 months ago when the first payment was not made, he could have had two years to sort it out. Now he has 4 days. CVS clearly needs to fix it.

@JPropaganda: I was wondering this myself...I mean, maybe this is him turning a frown upside down, but I'd be really, really upset and also just a little bit afraid for my health if I didn't have a steady stream of medication that if missed, could potentially lead to poor health.

@JPropaganda: Gallows humor.

@Kryndis: I doubt it. My pharmacy won't give back a prescription because there's no record of how many times it's been filled. For all they know, you could take it to another pharmacy and have it restart so you'd be getting more meds. The pharmacy will always say you need to contact your doctor for a new prescription, and since they have records showing when they last wrote you one, and for how much, they can revise their prescription notes as necessary.

@pecan 3.14159265: Which is not to say that he can't contact his doctor to do this, but if he can't get to his doctor's office, or the doctor isn't in that day...I don't know that other doctors would look at a chart and simply prescribe medicine for patients they haven't seen.

@VA_White: We all know many offices hire young women based on how well they look in a skirt and high heels - not on how compentent they are!

@hillsrovey: What I'm questioning, is why they were double billing for these meds. Isn't that illegal, and why did it take 21 months for this problem to emerge?

CVS was billing 80% to Medicare and 100% to N.J.P.A.A.D.- Instead of checking their systems and seeing 80% medicare paid for and noticing the error, they decided to cut off the PATIENT? Apparently, customers come first... after money.

CVS, shame on you. No one asked you to donate meds, but you could of gone the extra mile to recheck your billing system. I'm sure this poor person wasn't the only person using N.J.P.A.A.D. at a CVS, which makes me question their entire billing practices.

Makes me love my small local pharmacy.

Oh here is the bad part: You can only be on Medicare for three years after you get a Transplant then you have to get private insurance because you have to take Prograf and other anti rejection meds for the rest of the transplants life(on average 10-20years).

@zentex: @kewl132: Meaning that the actual cost of not dying each month is about $1500.

(And walking across the street to any other pharmacy other than CVS.... *shudder*)

This is exactly the sort of thing that wouldn't happen with single payer health care.

Also, if $300 just 20% of the cost? Are these drugs really $50 a day? Obviously the don't cost that much to make. Big pharma puts only 1% back into research. Lots of the research gets done at public universities on public money, who then sell the patents back to back big pharma.

In a single payer system, we could keep the drugs cheap. Or hell, in a sane system the public would continue to own the drugs it payed to research.

@SJPadbury:

Depending on how much he takes. I take 3mg a day of prograf and the Price lookup at caremark.com (CVS) is only $300 for a 30day perscription without insurance.

@jadenton: My wife takes a "generic" anti-nausea medication for her cancer treatment that costs about $1,000 for a months supply. We pay about $100 of that. "Generic" my ass.

@jadenton: Did you not realize that this was the government screwing up the payments? Sure, CVS was not billing correctly, but did no one over in New Jersey ever think to tell CVS "Hey, you're only supposed to bill..."

You might want to rethink your talking points...

@pecan 3.14159265: Just keeping his sense of humor or he might go insane? That's what I do.

@Tux the Penguin:

Read the update. This is CVS screwing up.

But three things prevent CVS from getting this right. The first is that its staffed by people who work at CVS. Nothing to be done about that. The second is that there are two parties to bill. The third is that every patient has to be billed differently. If every patient was cared for by a single payer, the billing gets much simpler and potentially fatal screw ups happen much less frequently.

@JPropaganda: Like Ted, I don't think he knows what LOL means.

Yes anti rejection drugs are that costly.

Rule 1

Always refill script after 3 weeks so problems have time to be cleared up

Rule 2
Get to know the head pharmacist so that when there is a problem you have an advocate

Rule 3
Use a mom and pop pharmacy if your medications are life giving, they WILL treat you like gold

@jadenton: Program does cost 1500.00 a month. Its a supply and demand thing I guess. My boyfriend also takes Celcept another anti rejection drog along with the Prograf and it costs about the same. Its crazy!

I can't understand why no one from the PAAD called CVS and told them not to bill them the full amount. Or why they never called Chris and asked him to take care of it at least.

I think that this is the first and only time I will ever see the phrase "LOL I have 4 days of anti-rejection meds to hold me over."

@jadenton: I worked for an ER billing company for years... the error rate in billing is MUCH lower than you seem to be thinking it is. Just look at it this way: if it was common, would stories like this be something to read about? No, it'd be another of "they screwed up again."

See, here's the thing. When my firm gets a bill for something and its more than what we've negotiated (just went through this for our office suppliers), we make a copy of the relevant part of the contract and show an adjustment on their invoice. We send it back and work it out.

Here, New Jersey just decided to not pay. Not tell CVS that they're messing up. Not to pay what they owed (trust me, that would have gotten CVS's attention). Not inform anyone. Welcome to a bureaucracy.

The question you need to ask is how many "errors" are acceptable? There's an old saying:

Pick two: good, fast, cheap. You can only have two.

Right now we have a system that is more or less good and fast. Canada is good and cheap. Would you rather fast and cheap?

@Tux the Penguin: So now it's the state's job to tell CVS how to do their job? CVS doesn't even know how to do their job correctly and you somehow expect someone else to help them out? This isn't kindergarten anymore; when you color outside the lines, there's no one to hold your hand and help you do it right. The state provides rejection codes, if CVS doesn't want to follow them, then how exactly is this "the government screwing up the payments"?

As a person who had a liver transplant just over 7 weeks ago, I too take Prograf. I too work with CVS. I will keep track of those scoundrels.

@Lucifer_Cat: Yeah, I thought it was supposed to be a hollow, sarcastic laugh. "Whoo, four whole days for my margin of error! I'm incredibly lucky!"

@Liam Kinkaid: Did you not read the part about NOT PAYING FOR TWO YEARS? Is there a human there thinking "hey, they aren't getting the message..." And yet, these are the people you want to put in charge of our healthcare.

I just find it funny that you read this and want to blame CVS in total. I want to pass some of the blame to New Jersey and you find that wrong...

Part of my kidney transplant evaluation was to prove that I could get my anti-rejection meds paid for. I know of people with full time jobs and what they thought was "good" insurance, get denied transplant surgery even though they had a donor only because they couldn't get the meds paid for!

Jebus tap dancing christ!

Is that true?

That's friggen' scary if it is... denied a life saving transplant procedure just because you can't prove that after you get it you'll be able to pay for your medication???

I mean, I can understand being denied because you haven't shown commitment to caring for yourself by continuing damaging behavior like continuing to consume alcohol, illegal drugs, not taking your prescriptions, showing up to doctors appts, etc... but not being able to prove your ability to pay???

@GenerousHelpingOf_GitEmSteveDave: Depends on the state law about what you can do to state agencies.

Illinois got so bad about reimbursements that they passed a law requiring the reimbursements to come with interest if they were too late. Things have improved since then, but a lot of providers won't wait for the state any more and want the patient to wait for reimbursement instead.

@Ronin-Democrat: You can't refill a script unless you have less then 6 days dosage. Then they tell you you need a refill. Then they tell you you need a pre-authorization form sent into the medicare D carrier (24 pages!) Then they deny it and you need an emergency appeal form faxed from the doc to the insurance company. THen it all repeats...

@emis: You have to take that medication or there will be a rejection of the organ. It may sound callous, but they don't want to "waste" it on someone whose body will just reject it, much like someone who won't quit doing drugs or drinking alcohol.

@Tux the Penguin: I'm glad in your world it's okay to do your job wrong and expect someone else to go out of their way to help you. If my company sends out an invoice to someone and they decide not to pay, we get on the phone and find out what's wrong. After all, it's (supposedly) our money. Maybe we did something wrong, that's why they're not paying. CVS figures they're infallible because they can't be bothered to pick up the phone and find out why they haven't been paid. Either they don't care all that much about their money, they knew they were doing it wrong for two years, or they thought they didn't have a right to the money. With such an egregious billing error (billing 500% of the correct amount), I'm willing to bet CVS was just waiting to see if the state would screw up and pay them anyway. CVS wants their money, they need to take the initiative. It's not the state's job to do CVS's job for them.

@pecan 3.14159265: Really? I've never had a problem in moving prescriptions, although 1. I stick to chain pharmacies and 2. I've never had a $3,000 a month script (PTL)...

@squinko:

Agreed... but I guess my point is that if you NEED a transplant, you also NEED the drugs, and the fact that you can't PAY mean you will die. I just assumed that if you needed a prescription like this and were not able to pay for it, you would qualify for public assistance--such as this fellow did via NJPADD and Med-B.

It's frightening to think that folks in the middle, who hold down $30-80K/yr jobs with private insurance might be DENIED a transplant because they can't prove their ability to PAY for a drug, yet do not earn little enough to qualify for the public assistance programs.

Scare thought for the average working American.

@jadenton: Also, if $300 just 20% of the cost? Are these drugs really $50 a day? Obviously the don't cost that much to make.

I've got 2 pharmaceutical reps in my family... both have million dollar homes and always show up in a new high end vehicle every year at christmas.

My grandmother is on an anti-cancer drug that costs over $3K/mo retail, she does not pay because she's older and it's covered by various federal and state prescription assistance programs (maybe even a veteran program because of her second husband) ...

It's disgusting that the pharma gets that much money from the public for life saving drugs and at the same generates such MASSIVE profits and astronomical salaries for their sales, marketing and executive employees.

Whenever I hear someone in the industry cry about the potential stifling of R&D should drug costs be capped I just look at my relatives, and the earnings reports of these companies. usually I feel like I need one of those $1000 anti-nausea pills jmujeff was talking about

This is ridiculous, I hope they get this figured out properly. I mean if he doesn't get the med's a perfectly good kidney would go to waste.

These insurnace companies need to be punished and fined large amounts in the millions each time they are found at fault. I gaurantee you they'll stop pulling this crap.

Does this man (who I feel truly bad for, because no one should be jerking him around now when he should be concentrating on recovery) live in a small town where CVS is the only pharmacy he can use? Surely there has to be some better option, right? It seems wrong to reward CVS with his business once they get the billing straightened out. Capitalism is only supposed to work if we can vote with our feet and let businesses that are incompetent fail due to lack of repeat business.