Friday, January 21, 2011

11.99999999999th Hour Success

So Xeloda, the chemotherapy drug I've been taking for the last several months, is an expensive drug. At my last insurance company, it was $3000/week, which equals, of course, $52000/year. For the most part, that was the drug company's part—I had a $50 copay that was unrelated to my out-of-pocket maximum: i.e. I paid it anyway. Xeloda is taken on a 3-week schedule of two weeks on, one week off. On January 4th or 5th, half-way through my first week of the latest cycle, and the last one paid for by my old insurance, I finally received my insurance membership number for my new insurance, contacted the insurance company, and emailed my nurse to let her know that a new prescription would have to be written, and where it would have to be sent. She did that by 6 Jan.

Since then, we've discovered the following things: for normal drugs, my mail-order pharmacy is Medco. For special drugs, i.e., Xeloda, Medco has a high-end pharmacy called Accredo that they contract with. For EXTRA special drugs, i.e. the ridiculously expensive Xeloda, a "preauthorization" is required from GEHA, the parent insurance company. This is a lot of levels to go through.

Once all of these levels and tasks have been successfully accomplished, the pharmacy calls me to extract my copay (in this case, almost $130 per three weeks), and set up delivery, which is overnight UPS.

Not surprisingly, accomplishing all these steps was not as easy as mounting a short, shallow marble staircase up from an infinity pool overlooking a Tahitian paradise. It was rather more like climbing an ancient ladder in the middle of the Amazon rainforest, with most of the rungs eaten out by poisonous giant termites. First, Nurse Deb spent a couple hours on hold trying to reach the preauthorization people so that she could get a form to fill out. Then the form had to be officially "received," days after it was faxed in. I called daily to check on progress; at one point they finally said "we'll call you at . . . well, it looks like we don't have a number for you. Where should we call you?" The day before yesterday the authorization hadn't quite been accomplished but looked like it was going to be by the end of the afternoon; yesterday, the authorization was accomplished and now the actual pill-pushers had to package everything up and then they would call me. That should've happened by the end of the day yesterday, as I need to take the drugs TOMORROW, SATURDAY, AND I AM LEAVING FOR HAWAII ON SUNDAY. I made this known to everyone I spoke with along the way.

Could they, in fact, send the drugs to me in Hawaii, if the process continued dragging on (I called and got a mailing address on the house we're renting)? Yes, but they only ship to Hawaii on Mondays and Tuesdays because the pharmacy is in New York and UPS doesn't guarantee one-day delivery except for the contiguous 48, and it would be the end of the week—i.e. about one week late—by the time they arrived there. Okay, can they ship to me, here, on Saturdays? Well, yes, if UPS delivers in our area on Saturdays. Well, do they? Well, I'll do my best to get things sent out today so they'll arrive Friday.

In the event, I did not get a call yesterday (SHOCKER), and so as soon as I hauled myself out of bed this morning and made my coffee (I'm not a total idiot), I put on my headset, got comfortable, dug in on the couch for a long siege of the Accredo customer service people (I was not getting off the phone until I knew I could get my drugs either by mail tomorrow, or somewhere within the city limits), and dialed.

One nice thing about the insurance company is that they almost always answer the phone before you go on hold. Ian, the nice-sounding gentleman this morning, picked up on the 2nd ring. I explained what I was after, and he asked the necessary questions (birthdate, spelling of name), and said "Well, let me put you on hold and contact UPS and see if they can do a Saturday delivery in your area. Should be two minutes."

A couple minutes later he was back. "They do a Saturday delivery, and will have the drugs to you by noon tomorrow morning. It'll be $126.49 copay. Would you like to pay that now? And set up an automatic payment for the rest of your prescriptions this year?"


I was, of course, greatly relieved—I can now continue to take my drugs, perhaps only a couple hours behind schedule (we have to take the dogs to Maple Valley tomorrow morning and so I probably won't have a chance to have my morning dose until early afternoon)—but also a little incredulous. I had been working on this prescription every day for a couple weeks. Everyone I talked to at Medco/Accredo claimed that they understood the urgency and marked in my account notes about what was going on, and yet—they did not have my phone number. They did not know that UPS would deliver to me on Saturday and, I can only assume from the absence of their call to me, would not have bothered to find that out. In all, I was almost deafened by the screeching grind of rusted, un-oiled, un-maintained gears, but I persevered to the last of my strength, and won. And I am STRONG.

I'm suddenly really looking forward to a week in Hawaii. I could use a vacation.

1 comment:

joel said...

STRONG and persistent! Way to go. Have a good time in Hawaii.