topic Re: Prescription Insurance Nightmare in Wellness

UPDATE: Prescription Insurance Nightmare

cheriere — Wed, 17 Jan 2024 01:10:17 GMT

I've spent the last 3 hours on the phone with my prescription insurance company. I received a letter in late September that my part d coverage would be changed unless I was willing to pay a higher premium to remain with my current provider. Because they've always been good about approving some very costly prescriptions I decided it was worth it for me to pay and stay with them.

A few days later, as instructed in the letter, I called to let them know I'd chosen to remain. I asked various questions, took notes & was told that they'd notify Medicare and I would receive a bill sometime in January. I'd ask to pay right then, but was told I couldn't.

Yesterday, I got a letter from the company dated December 27, congratulating me that the prescription my dr had requested authorization had been approved until December 31st 2024. Having thought this was surely the bill, I called today to ask when it would be sent. I was told that I'd been dis-enrolled in the plan because they hadn't heard from me???

I went over the date I called, everything we'd talked about, this letter etc. I was on hold while he spoke with others what seemed like forever. Then, was told if I still wanted to enroll I could but it wouldn't be effective until February 1st and I'd have to get ALL my previously approved medications re-approved.

Ultimately I signed back up. They still wouldn't let me pay today and offered no real assistance about my medications that I can't afford to pay for this month that are due Tuesday & Saturday. I was just so mentally frazzled at this point, I didn't bother with asking to speak with someone else.

Since these calls are supposed to be recorded and all, why is it they claim to be unable to find a record of my contacting them? I must've spent 45 minutes the first time I called going over all of my personal information & a million questions I asked about. Just wondering if anyone thinks another call Monday asking for someone higher up might help? This has got me tore all to pieces.

Re: Prescription Insurance Nightmare

Pezzie — Fri, 05 Jan 2024 22:49:10 GMT

@cheriere Definitely! Call and call and call and speak to as many people as you have to. They have a record somewhere of your call. Hope you get this sorted out soon. Good luck.

Re: Prescription Insurance Nightmare

Icegoddess — Fri, 05 Jan 2024 22:51:20 GMT

Sorry, I don't understand and can't help. I thought unless you wanted to change your Part D plan, you didn't need to do anything during open enrollment. It's my 1st year on medicare, but I did get an E-mail today from my plan inviting me to sign up for their website if I hadn't created an account previously.

Re: Prescription Insurance Nightmare

KathyM23 — Fri, 05 Jan 2024 22:54:30 GMT

@cheriere I would definitely call again and insist vigorously to speak to a supervisor/manager and if that didn't end to my satisfaction, I would ask for a higher ranked individual.

I also would check in with the State Department of Insurance (not just their customer service, but a supervisor or highter) to report this and see what steps you might be able to take to resolve it.

I would also put this in writing and not sure where to send it; maybe someone on this forum knows. Maybe the Attorney General?

Re: Prescription Insurance Nightmare

cheriere — Fri, 05 Jan 2024 22:54:58 GMT

@Pezzie Thank you 🙏 😊. My dad told me to do the same thing, just try Monday morning when I've had time to not be so stressed. I thought they should certainly have a record that I called. I just can't imagine why they'd claim to not have???

Re: Prescription Insurance Nightmare

PickyPicky3 — Fri, 05 Jan 2024 22:55:06 GMT

I'm so sorry you have to deal with this.

My first question is who sold you this insurance? Did you buy directly from the company or through an insurance broker?

If through a broker, you need to contact them and ask to get it straightened out.

Re: Prescription Insurance Nightmare

Effie54 — Fri, 05 Jan 2024 22:57:31 GMT

@cheriere Wow, that is a nightmare! Some of the insurers are better than others. I used to have UnitedHealthCare part D, but they weren't very good, and the price was high. What other insurance carriers would consider a tier one drug, United healthcare, considered a tier 2 with a higher copayment. I chopped them and opted for Aetna CVS. I remember having to call Customer Service for the United HealthCare plan and was rerouted several times. It took several calls to get to a Supervisor. So yes, I think if I were you, as much as a pain in the neck it's going to be, I would definitely pick up the phone Monday morning and ask for a supervisor. What they did was not only unethical but incompetent as well. Hang in there! I know dealing with Medicare insurance companies can be daunting.

Re: Prescription Insurance Nightmare

cheriere — Fri, 05 Jan 2024 22:57:59 GMT

@KathyM23 Thank you 😊. The insurance agent who took my information again today to re-enroll told me that she was going to report this to her manager, but that's not good enough. I feel like I'm owed an explanation and some satisfaction!

Re: Prescription Insurance Nightmare

cheriere — Fri, 05 Jan 2024 23:04:44 GMT

@PickyPicky3 No, this is through my Medicare.

@Effie54 Thank you 🙏 I used to have Aetna too and loved them. I'm calling Monday with a fresh head & by then I'm sure the appropriate amount of anger! I started wondering about the First Lady I spoke with...someone taking sensitive information about people and then NOT reporting they'd called! Something's way wrong either way!

Re: Prescription Insurance Nightmare

jlkz — Fri, 05 Jan 2024 23:07:29 GMT

@cheriere

Yes I understand how really totally upsetting this kind of game playing can be.

I would most definitely ask to speak to a higher up the first time something wrong occurred ( receiving a letter, being denied a benefit you were entitled to, disenrolling with no prior option, etc. ). AND, I would keep going higher and higher until satisfied. So, your question is answered: you should have " demanded " the higher up immediately and keep calling back until said person was on the line.

Next, gather all your evidence of correspondence, names spoken to and their dates as well as all the subjects discussed and their advice to you. Tell them you have been doing this because you want,to be prepared to write / speak with your state's attorney general ( get the name and use it ) as well as the Federal Trade Commision and the head of you state's health insurance department.

Touch base with your lawyer who could refer you to one that deals with this type issue.

Without knowing your age....suggest touching base with the state Office of Aging. Sooner or later someone at that prescription company will get involved or be willing to offer reinstatement with some type compensation for your mistreatment.

Again, sorry you are going through this.

We know how it feels because we spent two years dealing with the IRS and their unwillingness to acknowledge that they made one mistake that then lead to another year's refund being applied to their first mistake and then causing the subsequent year's taxes to be penalized because the refund they mishandled then caused another year's taxes to be penalized...

We got all the way to being threatened with freezing our bank accounts until some poor soul actually took the time to find the data that said we did indeed send our RMD's in in time and they had received, them. Nightmare city !!!

Re: Prescription Insurance Nightmare

Carmie — Fri, 05 Jan 2024 23:19:07 GMT

I worked for a health insurance company for over 25 years. This type of problem requires a letter of appeal.

It must be written and must state " I am appealing to have my RX insurance reinstated on December 31, 2023.........

Please tell the facts and dates you called and the approximate time of day you called.

Correspondence that is an appeal is regulated by the government. They must respond back in writing and must do it in a timely manner.

If you called in, the calls will be able to be listened to and the company must also keep records of all calls in their database.

A phone call to complain won't work. But an appeal letter is your best bet.

Re: Prescription Insurance Nightmare

Q-Checker — Fri, 05 Jan 2024 23:20:12 GMT

@cheriereIs this a Medicare Advantage plan or an original Medicare policy/plan that you are referring to? Good luck on getting it straightened out with the least possible further hassle!

Re: Prescription Insurance Nightmare

cheriere — Fri, 05 Jan 2024 23:24:53 GMT

@jlkz Thank you 😊. Very good advice. Luckily, I always take notes during calls like this. I pray it doesn't come down to having to get an attorney involved.

I have no idea how you didn't go completely crazy during all that trouble with the IRS, UGH! The only people definitely worse than an insurance company to have to deal with. I'm so thankful you were able to get everything finally straightened out. Again, thank you 🙏. I really do appreciate your taking the time to post.

Re: Prescription Insurance Nightmare

cheriere — Fri, 05 Jan 2024 23:29:47 GMT

@Carmie That's very helpful to know thank you 😊. I'm really glad I decided to post about this. You really are an expert.

I knew you all would know what I should say and do. Plus, it feels better just having others advice

Re: Prescription Insurance Nightmare

spumoni99 — Fri, 05 Jan 2024 23:31:57 GMT

Sorry your going through this. Whenever I deal with these hassles with health insurance I always think what if I was really super sick how would I have the strength to fight these things. It shouldn't be this hard!

Re: Prescription Insurance Nightmare

cheriere — Fri, 05 Jan 2024 23:36:52 GMT

@spumoni99 wrote:
Sorry your going through this. Whenever I deal with these hassles with health insurance I always think what if I was really super sick how would I have the strength to fight these things. It shouldn't be this hard!

Isn't that the truth! Hopefully, I'll have better luck Monday. I see my dr Tuesday, so maybe she'll be able to offer some assistance if things don't go so well. I really appreciate your post 😊 thank you.

Re: Prescription Insurance Nightmare

spumoni99 — Fri, 05 Jan 2024 23:40:51 GMT

@cheriere wrote:
@spumoni99 wrote:
Sorry your going through this. Whenever I deal with these hassles with health insurance I always think what if I was really super sick how would I have the strength to fight these things. It shouldn't be this hard!
Isn't that the truth! Hopefully, I'll have better luck Monday. I see my dr Tuesday, so maybe she'll be able to offer some assistance if things don't go so well. I really appreciate your post 😊 thank you.

You probably already do this but maybe get the name of the person you are speaking too. I recently retired and put my husband on medicare, where I worked he didn't need to go on medicare until I retired. Anyway they were very helpful at the social security office. Not sure if the social security office could help you?

Re: Prescription Insurance Nightmare

Effie54 — Sat, 06 Jan 2024 00:06:39 GMT

@cheriere wrote:
@PickyPicky3 No, this is through my Medicare.

@Effie54 Thank you 🙏 I used to have Aetna too and loved them. I'm calling Monday with a fresh head & by then I'm sure the appropriate amount of anger! I started wondering about the First Lady I spoke with...someone taking sensitive information about people and then NOT reporting they'd called! Something's way wrong either way!

I feel for you. Yup, I remember the headaches I had signing up for a Medicare part D. Ugh.....UHC was a hot mess. I was calling Jamaica, I think, we couldn't understand what each other was saying ; they were clueless. I switched happily to Aetna and have had good luck with their plan and their Customer Service. I don't know what company you're dealing with now....but what they did is unethical. It's on them to fix it. I also know how anxiety producing it is to begin to explain the predicament when you start calling them again. I've been there. I had to insist on talking with a Supervisor. Fingers crossed!!🤞🏻

Re: Prescription Insurance Nightmare

cheriere — Sat, 06 Jan 2024 01:01:24 GMT

@Effie54 That was exactly how the first two people I spoke with were. I had to get them to repeat everything. But, I did make sure I understood even if I had to make them explain it over and over. The last lady I spoke with today, thankfully, was easy to converse with.

Like you said, unethical and unprofessional. I'm sure they have a record of my first call & if not I'm gonna demand to know why! I really do appreciate your taking the time to talk to me about this. It feels good just to be able to share it with someone. 😊💕

Re: Prescription Insurance Nightmare

ECBG — Sat, 06 Jan 2024 01:37:47 GMT

Call and ask for a supervisor. Best of luck!