Why I'm switching back to the HMO

(Caution! This is a rant where I'm just getting a lot of my frustrations towards my insurance company off my chest. I know I'm fortunate to have health insurance at all, but still things should be easier than this.)

I'm on hold right now with my pharmacy. I'm trying to get my next sandostatin shot set up, and it's so complicated.

Yesterday:

• Call the pharmacy to order the sando.
• Because sandostatin is considered a "specialty" drug, I have to be transferred to the specialty pharmacy.
• There's no prescription on file, so I called my endocrinologist's office to have them fax the prescription in to the pharmacy

Elapsed time, half an hour

Today:

• Call the company that provides the nurse that will inject the medication to schedule. They can't tell me when my appointment will be, they have to call me back to let me know what time they can do it.
• Call the pharmacy back to check on the status of my order from yesterday.
• The prescription was received, but now the insurance has to approve it.
• Call the insurance company, they need the endocrinologist's office to call them to approve it
• Call the endocrinologists office, left a message asking them to call the insurance company

Today's total elapsed time on the phone, 1 HOUR

The sandostatin order is still not complete, and if it isn't shipped today for delivery Friday, I will have to wait till Tuesday for delivery because they don't do Monday deliveries (no one can send it out on Sunday). I was supposed to have my injection yesterday but I've been traveling and I won't be home till Saturday night.

This kind of thing is typical for all my medical dealings. I am doing the phone tag rounds right now for my upcoming colonoscopy as well. In the past, this is what would happen:

• Hospital sends me bill for full price of procedure/medication/whatever
• I call hospital billing for explanation, they tell me it is because the insurance denied/did not respond to their requests
• I call the insurance company to tell them that I'm being billed, and insurance should be covering it
• The insurance company sends a request to my doctor's office for more information
• Doctor's office did not receive/respond, so I have to get the forms from the insurance and fax it to my doctor's office myself
• Hospital sends another bill showing that I still owe the full amount
• I call the insurance company to ask about the status of the doctor's forms
• The insurance company tells me that they did receive the completed forms, the system just hasn't been updated yet
• They update the system and authorize payments to the hospital
• Call hospital with the insurance company's payment confirmation numbers

Of course, it's not as straightforward as I've described above. There is usually some extra following up along the way. Imagine long hold times, phone trees (press 1 for ....), repeating the same information over and over (account numbers, security verification questions, contact info, etc). And for what? I still have a huge deductible and multiple co-pays that do not count toward

I miss things being easier at the HMO- everything was so integrated and I could even order my refills online, then just pick it up. No approvals and authorizations between the doctor, the insurance, and the pharmacy to juggle. I hear things are also better in countries with nationalized healthcare programs. FINGERS CROSSED for healthcare reform! Improve patient quality of life!

Update: I just got off the phone with the insurance authorization people and they got the information they needed from my doctor and now they are waiting for their medical review people to look at it. The pharmacy had told me earlier that my order had a "STAT" priority, but the insurance authorization people said that my review was on the normal timeline. It is now on the STAT review timeline. Elapsed time for today is now TWO HOURS!