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A Funny Thing Happened While Refilling

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So writing this I am still a little miffed about the whole situation – I am warning you ahead of time it may turn into a venting session.

However, it may also save you a bunch of money.

A couple of weeks ago, I decided it would be a great idea to switch from picking up my prescriptions at the pharmacy each month to getting them in three months supplies through the mail. It is supposed to save money because essentially you get three months for the price of two.

Right around my birthday I received the prescriptions in the mail. I received a three month supply of insulin but only one month’s worth of strips. Odd…

Me (about a week ago): I am calling about the prescriptions I received. I think there is a mistake because I received three months of one but only one month of another.

Medco: Let me look that up… (hold music)… According to our records your doctor only ordered you a month’s supply of insulin.

Me: That doesn’t make sense. Why would they do that if they ordered three months of the other?

Medco: We do not question the doctor’s orders because we don’t know what other situations are going on.

Me (kinda dumbfounded): Okay…. What should I do about it?

Medco: Call your doctor and have them write a three month prescription.

[Later in the day]

Me: Hi. You might remember me from when I was in the office last week. You gave me free meters for the weight loss challenge I am in.

Nurse Joe: Yeah. How’s it going?

Me: [long explanation of situation thus far]

Nurse Joe: You’re right, that doesn’t make sense.

Me: Okay. So what should I tell Medco?

Nurse Joe: Nothing. I will call them and get this straightened out.

Me: Thanks.

[Two days ago I receive notification that an order has been processed but in the Medco system you cannot view the invoice until it has been shipped. Today the order has been shipped so I can view it and find out that I am charged another copay. I thought this was odd, but not too odd. Just odd enough to call Medco and inquire.] Congrats if you’ve made it this far – you are about half way through.

Me: [explaining the situation and my question]

Medco jerk: Gee I don’t know about the double charge. Let me look it up. [hold music] Let me read from the policy for you. Any time another diabetic supply is ordered within 24 hours of an order of insulin it is subject to a single co-pay.

[Did you catch that?!?!]

Me: Great. Well, I ordered the strips and insulin through you guys at the same time so why do I have to pay two co-pays?

Medco jerk: You ordered the one month supply at the same time as the insulin but the three month supply was a separate order.

Me: But that is not my fault. I ordered them both at the same.

Medco jerk: We are not able to question the doctor’s orders and have to fill them as-is. There is nothing we can do. [long pause]

Me: Okay. Can I talk to your supervisor? [I have never asked that ever before for anything]

[basically the conversation with the supervisor went the exact same with me not believing them and asking for them to send me the original prescription]

11:15 AM

Me: Hi, Joe. It’s Sara again. You may remember me from….

Nurse Joe: Sure. What can I help you with?

Me: [Medco speech again]

Nurse Joe: You’re right that’s not fair. Let me call Medco and see what is going on and I will give you a call after lunch.

Me: Thanks. I really appreciate it.

1:30 pm

Me: [thinking – Hey I wonder if the one co-pay thing is just for Medco or any time I fill a prescription. I better call my insurance and check it out. Come to think of it – sometimes I only pay one co-pay at the pharmacy and sometimes I get charged for both refills. I always attributed it to the time of the benefits cycle that I filled it, but maybe it isn’t]

Insurance Guy: How can I help you?

Me: [reciting the now impossibly long story]

Insurance Guy: Gee. I have never heard anything like that before. Can I put you on hold and check on that?

[I am on and off hold while he checks on the situation]

Insurance Guy: Wow. That is actually part of your policy. Any time you fill your insulin prescription with another diabetic supply it is subject to only one co-pay.

Me: [incredulous at this development] Okay. Then I definitely overpaid at the pharmacy. Is there any way for me to get my money back?

[More time on hold while he tries to figure that out. He looks at my prescription history at finds at least four times in the past year and a half that I was overcharged. In the next three to four weeks I will receive a check for $100. It would have been more, but there were times when I only refilled one prescription or the other. I ended up asking to be forwarded to his supervisor too, but to tell this one what a great help he was and how he went above and beyond for me. I hope it helps him. He could have ended the conversation at the very beginning saying he had no idea what I was talking about]

3:30 pm [significantly after lunch but nevertheless]

Nurse Joe: Hey I talked to a guy at Medco and they fought me on it for quite a while and really didn’t want to do it, but they will be crediting your account for one of your co-pays.

Me: Thanks. You are great. I really appreciate you making the extra effort for me.

Nurse Joe: No problem. You made the end of my day difficult but I am glad to help.

I Y Nurse Joe and Insurance Guy!

Congratulations for making it to the end of this story.

Now call your insurance company to see if you can save money too!!!!!

7 responses

  1. I really hate Medco. Every time I try and order my reflux med they inform me that there is a cheaper alternative. I can’t take that, but they don’t care, it’s cheaper. They truly are a pain to deal with.

  2. hey what mail order pharmacy did you decide on. i’ve been thinking for a while that i’d like to do it that way … and do you really get three months of supplies for on two months worth of money? just wondering 😀

  3. The mail order pharmacy is actually called Medco.
    It is usually tied to whatever health insurance you have, so if you are looking for one that is where I would start.

  4. I hate Medco, and am convinced that part of their mission is to make it almost impossible for me to get infusion sets, which they insist that I order from them. Congrats on actually finding a living, breathing, thinking human to talk with there. If you have his direct line, please pass it along.

  5. I hereby award you (and your endo), the 12 out of 10 award for effort.

    It would be nice if everytime one of us struggled with insurance, it got easier for the next person.

    Unfortunately it doesn’t.

    Oh well. I’m glad you got it all sorted out. I wonder what the stress did to your BGs.

  6. Thanks Bernard!

    I have actually have referred a few Type II co-workers to my endo because I like them so much.

    I have been a little higher than normal lately but I am generally not very sensitive BG-wise to stress – just rice and pasta 😛

  7. My insurance doesn’t do anything that crazy, but I will hopefully remember this if/when I grow out of my parents’ insurance.

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