"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)