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Tuesday, June 7, 2011

What I've been up to....

I have not posted about this but also did not want to forget everything I have been going through. Also when this is all no longer an issue (reflux and trachea) and I am finally breathing a sigh of relief it will feel amazing to look back and what all I am finally done dealing with... If supermom was an occupation or hobby I think I'd fit that title lately.
I am NOT one of those people that writes letters to companies when I am mad, I wish I had that much time on my hands because I feel that the consumers opinion should be the companies #1 priority. But this letter had to be written, I cried too long and hard about this to let it get swept under the rug... which I'm sure it will anyway.
If you read this, well...Good for you! I'm proud! But if you don't, I understand, its lengthy, boring, and well all around bitchy true!

GHP Member Appeals                                         6-07-11

Dear Sir or Mame,

A Medco/GPP employee advised me to write to member appeals in regards to the current situation I have been dealing with regarding my son.

My son is only 8 months old and on 2 prescriptions he takes multiple times daily. We cannot go without either of them.

I get them both filled together about every 30 days, at the end of April I filled both like normal then we were off to North Carolina to visit family. When we left I forgot to grab both medicines (they are both compounded/refrigerated so I over looked them) I had a doctor appointment with my son the next day so after discussion with a nurse she contacted Medco/GHP, and Walgreen’s (our pharmacy) I told them all that if this was a issue I could have our out of state family overnight me the refrigerated prescriptions. I was informed that this time they would overwrite and refill for me ahead of time due to my circumstances and all would be okay.
I went up and picked them up that day, May 3rd I believe.
Like clockwork a month later I called in to get both filled again and I was told my insurance would not be paying for them because it was too soon. After I told my story they said they would call and call me back. When I heard back from them they said they called twice but did not know what was going on and it was now my responsibility to call. In the meantime I had been in conversation with the nurse in our office and she had no idea why you all would be saying this.

So in I called…. After a 2 hour plus phone call taking up my time at work and many tears shed by myself, my son, and I’m sure your customer service rep I talked to, and also being transferred to multiple different departments and supervisors. The conclusion was came to that when the original overwrite went in the (careless) person at medo/ghp put this in for my son as a “vacation overwrite” Which allows you to get them closer together but acts as a circumstance where you would be using both, like if you were going on a long trip. NOT if the meds are lost/spilled/etc… So you would cover my prescriptions again but not for 60 days.

This is completely incorrect and not what your employee was asked to do. At the same time I called Walgreen’s because at this point I was going to try to have family overnight the original ones if they still had them. Walgreen’s informed me that the medicines are BAD after 30 days and I cannot distribute them to my son.

So I am furious that in the beginning I could have gotten them and all would have been okay. But I was told not to and told that GHP was taking care of this for me. Now come to find out you did not take care of this or handle it properly, I cannot get the scripts because they are old. SO if in the beginning I was told this was not covered I could have had them sent and everything would have been fine, but since your employee said they can overwrite this and take care of it NOW those prescriptions are expired and trash.
I am now expected to pay out of pocket, I was told now that this is the only way to get things back on track for my son’s prescriptions and them you would cover them after the 60 days has passed.
I was APPAULED there is nothing you could do, as this being a big mistake on your company’s part and compromising the health and well being of my baby boy.
I called my doctor (who was also in disbelief over this circumstance) immediately put us on a different brand of reflux meds to help me out with these OOP costs, and I have attached copies of both of my receipts for this and the Bethanocol. My husband and I are paying each and every bill as it comes in; we are already at my son’s 2500 deductible for the year.
Not only would I like to be reimbursed for the meds, my time, pain and agony. I would also like you to look at the phone/member records so this employee can be made aware of everything they have put not only my family through but also all the employees that actually tried for hours to help me through this…. With the only final answer being they could not help.
I look forward to hearing from you soon,
Wilson

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