Tuesday, June 9, 2015

I Can't Make This Stuff Up, You Guys

Yesterday, I opened my mail to find this treasure: the bill from my first Rituxan infusion.

The actual chemotherapy medication I received is listed as costing $10,237.40. There are also $628.15 in various materials and administration fees. Luckily (hahahahah!) I'm only responsible for $6,044.81. 

Let's all just cry a little bit over that number. That's completely insane.

Ok. Moving on.

The good news is that the Rituxan Co-Pay Card Program will help me cover the cost of the medication itself, which is $5,610.26 after my insurance company's generous contribution. Once you request the Rituxan Co-Pay Card, get it in the mail, and register it, all you have to do is submit a copy of a detailed Explanation of Benefits to the program and they will cover up to $10,000 a year in medication costs. (Don't ask me what happens if I end up needing more medication than that. I can't bear to think about it yet.)

So the bill comes, APL tracks down the EOB, and I log on to the Rituxan Co-Pay Card website to find out where to submit the paperwork.

"I'm a Rituxan patient" I click. 

"How It Works" I click.
Once you enroll and register your card, just give it to your doctor’s staff when you get your Rituxan treatment. You or your doctor's office will have to send copies of your detailed Explanation of Benefits (EOB) from your health plan so you can use the card.
Right. Ok. Do I mail them? Fax them? What address? What fax number? Nothing on the "How It Works" page explains that, so I click "FAQs"
Will I be asked for other information throughout the 12-month period?

Yes. You will be asked to send copies of detailed Explanation of Benefits (EOB) statements. This information is required to fund the card.
But you don't think the FAQs are an apporpirate spot to tell me where to send/fax them?!?! Finally, after searching around through all the menus, I find a box in the side bar that has a phone number and a fax number. But it doesn't specify if that is the number where you are supposed to fax the EOBs, or even if you are supposed to fax the EOBs. So, instead of blindly faxing my medical information into the void, I decide to call the number and ask 
Welcome to the Rituxan CoPay Card Program. We provide fast and convenient co pay support to eligible patients.
Press 2 if you are a Rituxan patient.
Ok, I’ll press 2. 
From this menu you can request a card and register it.  
Umm…are those the only options? I already have a card and it is already registered. How do I speak to a human to get my question answered? I press 0, trying to get to a person but I end up in an endless loop where the recording just keeps telling me my answer is invalid. I finally give up, hang up, and call back to start over. Somehow I finally manage to get the recording to say:
If you would like to speak to a representative, please answer a few questions first.
Um, ok. Then, no joke, it asked me all the following questions before it let me speak to a human. And, keep in mind, after I answer each of these questions the recording also repeated my answer and made me press 1 to confirm my answer.
Please enter the member ID number on your card.

Please enter the last 4 digits on the card.

Has your doctor prescribed Rituxan for one of the following conditions: press (1) for moderate to severe rheumatoid arthritis.

Do you have a commercial health plan?

Are you at least 18 years of age?

Are your prescriptions covered in whole or in part by any state or federally funded programs, such as Medicare, Medicare Advantage, Medigap, Medicare Part D, Medicaid, Managed Medicaid, TRICARE or Puerto Rico Government Health Insurance Plan.

Do you get free medication from the Genetech medication program?

Do you live in a state where copay assistance is prohibited by law?

Please enter your doctor’s 10 digit phone number starting with the area code.

Please enter your 10 digit phone number.

Please say and spell your first and last name.

Please say and spell your mailing address.

Press 1 if you are a female.

Please enter your date of birth.

Please say the name of your health insurance company.

Please say the type of health insurance plan you have.

Please say the group number.

Please say the member number.

We need your social security number.
Twelve minutes and 48 seconds into the call (my second call, mind you) the recording finally starts talking about how I will be required to provide a detailed Explanation of Benefits. All right! Now we’re talking! Unfortunately, this is apparently also not the appropriate place to tell you how to actually do so. The recording goes right on rambling. I finally get frustrated and press 0 again. 
Your call is being transferred….All representatives are currently busy. Please hold. 
At least fifteen minutes in to my second call I finally get a human. The first thing I do is ask if there is a magic way to get to a human instead of talking to a recording for 15 minutes. Apparently, you can get to a human if you press 0 but only if you press 0 before answering the question about what kind of patient you are. So since I pressed 2 to say I was a Rituxan patient before pressing 0, it put me into an endless recording loop hell. Ok great. So now I know the secret. I ask for the fax number. She gives it to me. I thank her and finally hang up.

It is only then that I notice that the fax number she gave me is different than the one on the website. So I call back and use the magic secret 0 to get to a human. I ask the new representative to confirm the fax number. He asks what kind of patient I am and then confirms the number that the previous representative gave me. He says the one on the website is a generic fax number, which I suppose probably means that if you send your EOBs to that number they will get “lost," making you ineligible to receive co pay assistance. 

So, I ask, can you tell me where the correct fax number can be found on your website?

The agent goes quiet for a while. Sounds like he is clicking around on the web site himself. Finally he says he guesses it isn’t actually on the website anywhere. He says he never noticed that before.

So, I ask, is the only way to get the appropriate fax number to call? And either sit through the recording questions or know that you can press 0 before answering any questions?

He confirms that is true. Fast and convenient co pay support indeed!! Especially since it isn't 1980 anymore and I don't have a fax machine - so now that I have the number finding a fax machine is just another hurdle.

And, P.S., all of this was accomplished while paying for childcare for OZL and during CZL's nap, which is the time I am supposed to be using to get my work done so we can pay said medical bills. 

To be fair, the representative I talked to did apologize to me and promise to “bring it up,” though he didn’t say where he would be providing that feedback. And, as a call operator, I seriously doubt that feedback is going to make it anywhere. But I guess that is better than nothing.

If you are a Rituxan patient and need to fax your EOBs before you can use your co-pay card, let me save you several hours of your life: the number is 888-332-9864.

Don’t get me wrong – I am really grateful that copay support exists. I certainly would not have been able to try Rituxan without it, and so far I am captiously optimistic that this mediation is going to help me get my life back. But you have to admit that this seems like a ridiculous number of hoops to make someone jump through and still claim to be “helping” them.


L."Wren" Vandever said...

Mariah, you have the patience of a lioness stalking a gazelle. Sometimes I think this sort of problem is the result of serious overthinking and overkill on the part of the company; other times I think they're just idiots. Either way, it seems terribly unfair that a patient who's already coping with severe pain and disability also has to cope with this kind of hassle.

Thanks for telling us the story.Thanks for passing on that precious phone number! And thanks for being you.

Wishing you the best of luck with Rituxan, now that you have it. And sending you a warm-but-gentle hug, too. :o)

Unknown said...

I think you should post your blog on Genentech's website. Oh, that's right they never look at it. Question: When i was on Rituxan, I took my co-pay assistance card to my doctor's office, they made a copy, and they were the ones to fight with Genentech on my behalf. Here's hoping your docotr's office provides the same service.

Lisa Emrich said...


I can sympathize with you! It used to be much easier to reach a real human in a timely manner years ago when the program was the Rituxan for RA Experience Program. You could call the number and Bettina would answer. if you were on hold for a brief time period, Bettina would still answer. She even seemed to remember you from one call to the next when you might be trying to figure out what was going on. I blogged my first experience with the program back in 2010 (http://www.healthcentral.com/rheumatoid-arthritis/c/72218/102387/nav/). It took a lot of back and forth to get that first application and payment process complete.

Then I learned the hard way that you never, ever....ever....want to let your enrollment lapse. I mean, ever. When you receive a letter informing you to renew (even if they've changed the name of the program and you thought that they were sending you info for the other program you did not use), you better renew because they've changed the time frame from when you can receive treatment and still enroll into the program from 90 days to 45 days. Don't know about your insurance company and the hospital billing department, but 45 days can pass very quickly without paperwork being complete such that you can demonstrate exactly what were the Rituxan charges, based on an itemized bill lining up with an EOB.

I hadn't tried looking for the fax number on their website. It used to be very clearly shown on the back of their brochure (before they merged programs). now it is found once on page 4 and once on the patient info release form. I'd appreciate it if they offered a way to email or upload pdfs/scans rather than require fax.

But it's great to learn what the magic formula is for reaching a human more quickly. Last month I sat through that entire message system just to get a confirmation that my account was active BEFORE I went for recent treatment.

I have a post scheduled to go up later this week that discusses a different aspect of the Rituxan treatment/hospital charges/insurance coverage/patient billing aspect of paying for treatment.

In my case, the hospital charges come in well below what insurance has contracted to pay. But my copay is based on the higher amount which insurance happily pays. For a full round (two infusions) of treatment the hospital charges total approx. $18K and insurance allows about $23K. My copay is approx. $2300 of which the copay assistance program will pay close to $2000.

I hope that everything else goes smoothly for you from this point forward. And I definitely hope that Rituxan works to reduce your RA. It continues to work for me.

Best of luck.

Anonymous said...

My wife takes this medication for RA. This co-pay program is very beneficial for the average person that can't afford these high priced drugs. However, the Rituxan co-pay card program is difficult and frustrating. The people who administer the program, and answer the phones are rude and not very helpful, in addition to changing the requirements for required paperwork submissions each time. I just spent over ONE hour on the phone with our insurance provider and Rituxan attempting to get the card funded for the last infusion. This was NOT the first time I needed to do the same thing, provide documents or explanations that even the insurance company said were in violation of HIPAA laws. Finally, Rituxan agreed I submitted all the same documents as before and funded the card ( over $2500. ) but not after I wasted an hour arguing with them. We have used Enbrel, Humira, Orencia and countless other drug co-pay programs, and never have we encountered a program like this one that doesn't seem to care about the patient. I will advise our Rheumatologist that perhaps we need to try another medication. Maybe Genentech needs to wake up and change the program administrators.