Tuesday, December 1, 2015

I. Can't. Even.

You guys. I know it sounds like I am broken record complaining about this topic - but this crazy stuff keeps happening to me. And so I keep recording it in the hopes that someday someone somewhere will look at these problems and say: this isn't really an acceptable way to "help" patients.

Today I used some of my very limited childcare time - time I am supposed to spend working to earn money to pay my ridiculous medical bills - to yet again try to figure out how to pay my most recent Rituxan bill. 

I already attempted to do this, for the second time, on November 18th. On that day, if you remember, the Rituxan co-pay representative I spoke to told me they had not received the EOB that my husband faxed on November 12th (despite us having a message with a "reference number" saying they had, in fact, received it). I saw no point in arguing with her at the time, and so we faxed it again (including faxing it to a "direct line" the representative gave us that never worked) and we put a copy in the snail mail to an address she gave me, just to be safe. Then I purposefully waited long enough to make sure that, even if the fax didn't arrive or got lost, the duplicate snail mail one would have time to arrive.

So today, two weeks later, I called back. I pressed the secret 0 key and was connected with a representative. I explained that I wanted to find out the exact dollar amount that had been put on my card so I could pay my bill. (Because last time, even when they did receive my EOB via fax, they put the wrong amount on the card and I couldn't pay my bill until they fixed it.)

I kid you not, the representative responded: You haven't faxed us your EOB yet. 

I almost lost it. It took a real effort to remember that whatever was going on here was not the direct fault of the individual I was talking to. I took a deep breath, told him that I understood it was not directly his fault, but that this was beyond ridiculous. That we had faxed the EOB three times and sent one via snail mail. 

The representative disappeared for a few minutes and, quite miraculously, "found" some of my EOBs. He said they would get the EOBs processed by the end of the day and someone would call me back to let me know when it was done. I hung up, relieved that it was finally over - for at least another six months until I have to do it all again.

Unfortunately, less than 10 minutes later, he called me back. I had two Rituxan infusions, but he insisted the EOB we sent only covered one of them. And, in any event, it wasn't detailed enough for them to fund the card. Instead I would need to send a "claim 1500 form" showing the charged amount for the medication, including a J-code or listing the name of the medication. 

I took another deep breath and reviewed the FAQs on their website
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.
If the EOB I sent was sufficient last time, why wasn't it sufficient this time? Why didn't the website FAQs mention the possibility that a claim 1500 form or J-code might be necessary? I already know that type of form isn't easily available on my insurance company's web portal - how do I even get such a form? Assuming I am able to actually the needed form, why isn't the 888-332-9864 fax number listed anywhere on the website? Is that where I should send it? What about the two other fax numbers I have been given? What do I need to do to assure that the fax is actually received and processed instead of being told they never received my fax?

To his credit, the representative did his very best to answer my questions, though I know he was overwhelmed by my frustration. He advised me to call my medical center for the claim 1500 form, that they would have to provide that form to my insurance to get paid so they should  be able to get me a copy.  He recommended sending the fax with a cover letter addressed to the claims center, including my Rituxan co-pay card member ID. This was good advice and I thanked him for it. But I couldn't stop myself from asking: why does this process have to be so difficult for patients? Couldn't the co-pay "support" program list some of this information on their website to make it easier for patients?

He didn't have any more answers for me, so finally I asked if there was somewhere I could provide some feedback. A manager perhaps? It turned out the project manager was at a staff meeting, but he connected me with his supervisor. I told her about my difficulties and frustrations with this process, and asked if there was anywhere that I could provide feedback so that hopefully this process could be made easier for future patients. She said she didn't think the company had any sort of feedback process in place. So I asked who was in charge of the project, and could I please have an email address for that person? She promised to forward my information to the project manager - and she said that the project manager would contact me to hear my concerns and suggestions. 

I sincerely hope she does. I would really love to provide some constructive feedback to help future patients - and I do promise to keep my frustration at bay as much as possible. Because, as I have said before, I am beyond appreciative for for this financial assistance. I wouldn't have access to this life-changing medication without it. But this process is just so so so difficult - and patients with chronic illnesses already have enough on their plates. Someone somewhere must care about my suggestions for things they can do to actually make this easier for us!


1 comment:

Lene Andersen said...

Well, you do have to spend the energy the medication gives you on something, right? I think it's perfectly nice of them to give you a make-work project!

(That was sarcasm. Going to go bang my head against the wall in commiseration now)