Wednesday, October 19, 2016

The Never-Ending Quest to Pay For Expensive Medication

Well, I finally have at least a little good news on the "managing to pay for extremely expensive medication" front! 

For one thing, the bill arrived from my last Rituxan infusion and - because we've already met our deductible and out of pocket maximum for the year - it was only $165.52!! Which seems a lot easier to stomach than $6K! (Though let's just not think about the amount of money that went into meeting our deductible and out of pocket maximum, shall we?). But even though it's a relatively small amount of money, I would still prefer to have it covered by my copay assistance card so I can save my HSA money for other inevitable expenses. 

So I went about the business of submitting my Explanation of Benefits so that my card could be funded and I could pay my bill. And the other good news is that the copay assistance program now has an online portal, where you can see information about your account and upload forms directly - instead of having to find a medieval fax machine. So it seems that my attempts to provide feedback on some of the issues I encountered were worthwhile.

It's a really big improvement - but that being said it still leaves something to be desired. And while I know these accounts of my issues are not particularly riveting, I think it's important to record them so that there's some awareness about how much patients struggle with programs that are supposed to be helping them.

I logged into my Dashboard last week and uploaded my EOB. Then, since I learned last time that my EOB wasn't enough, I also uploaded the claim 1500 form (which I had called to ask my doctor's office to send as soon as the bill arrived because I knew I would need it.) I didn't get any sort of confirmation that the files had been successfully uploaded other than some small green text that said "Patient File Uploaded." 

I gave them a week to "process" my information, then tried to pay my bill. But, of course, I couldn't - so I had to call and see why. The first thing that happened was the representative tried to explain that my EOB wasn't sufficient because it didn't include the name of the medication. I told her I already knew that, which was why I also submitted the claim 1500 form. But, of course, the claim 1500 form "wasn't received." I have literally never had an interaction with this assistance program without getting told something I definitely submitted simply "wasn't received." 

But since they had received my EOB and determined that it was insufficient, I asked why I hadn't been in any way notified of the problem. The representative said there was no fax number to fax me back. I told her that was because I had uploaded the form online and I asked why the notification hadn't gone into the "notification" section of my Dashboard. I was told that "wasn't her department." 

So then, while I still had the representative on the phone, I uploaded the claim 1500 form yet again. When I got the tiny "Patient File Uploaded" confirmation, I asked if she could at least confirm that the document had been "received" this time. She couldn't. Apparently someone is supposed to call me back in 24 to 48 hours to let me know. 

There's a part of me that doesn't want to complain about this issue, because the online system they have now is certainly an upgrade from the previous system and I honestly do appreciate that. And, as always, I am grateful for the monetary support because I certainly would not be able to afford this medication without it - and it seems to be working


But I'm sharing this experience because clearly there is still work to be done. Because it literally never goes smoothly. And I really wish it would - because there are a lot of other ways I'd rather be spending my time.

No comments: