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Author Topic: Desperate for some help with my insurance  (Read 945 times)

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Offline hereinny

  • Member
  • Posts: 69
Desperate for some help with my insurance
« on: November 26, 2013, 09:06:08 AM »
I currently use Express Scripts.  The have been my prescription insurance carrier for 25 years.  When I began meds 4.5 years ago, they screwed the prescription up every singe month.  Billing was wrong, lost prescriptions, excessive wait times, etc.  Since starting meds, I have had to make over 500 (no exaggeration) in order to get this prescription once a month.

They have since began a specialty medication branch.  This is called Acredo.  The problems have become much worse.  I can not use any online or automated phone system to order my prescription each month.  It can not have automatic renewal and they require a phone call each and every month.  This is the 3rd month since the switch and each time it involves 2 hours on the phone.

This story goes on and on.  Every month they put me through this.  I cant afford to just no use my prescription insurance.  I cant  go to the benefits manager at work because the first thing they ask is what is the medication for?

Who can I complain to?  This is insane and there is no question it is being done to harass me because of the nature of the illness.

Can someone please tell me where I can go with this?

Offline Snowangel

  • Member
  • Posts: 1,413
Re: Desperate for some help with my insurance
« Reply #1 on: November 26, 2013, 11:36:00 AM »
Hi there!
Are you in Tennessee?

It looks like people have filed with the Better Business Bureau, I don't know if you want to go that route?

http://www.bbb.org/memphis/business-reviews/wholesalers-and-distributors/accredo-health-group-in-memphis-tn-15005188/complaints

2 hours on the phone is ridiculous!!

Good luck,
Snow
Of all the things you wear, your expression is the most important

The heaviest thing you can carry is a grudge..

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Offline mitch777

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  • Posts: 3,549
Re: Desperate for some help with my insurance
« Reply #2 on: November 26, 2013, 11:55:56 AM »
Just went through the same thing with Acredo myself last week. Pure torture. >:(
31 years hiv+ (oct. 2013) with a curtsy.

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Desperate for some help with my insurance
« Reply #3 on: November 27, 2013, 06:23:13 AM »

I cant  go to the benefits manager at work because the first thing they ask is what is the medication for?


I could be wrong, but I'm pretty sure that according to HIPAA laws, a benefits manager at your place of employment is not permitted to ask such a question as it would breach your confidentiality.

You should look into this.
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline bocker3

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  • Posts: 3,391
  • You gotta enjoy life......
Re: Desperate for some help with my insurance
« Reply #4 on: November 27, 2013, 08:02:47 AM »
I could be wrong, but I'm pretty sure that according to HIPAA laws, a benefits manager at your place of employment is not permitted to ask such a question as it would breach your confidentiality.

You should look into this.

I am not an expert but, I don't think HIPAA precludes someone from asking the question -- it precludes them from sharing the info if the question is answered.  I would NOT answer, if asked.
It shouldn't matter what the med is or what it is for - if the contracted benefits company is not meeting the standards of the company, a complaint is in order and would, I hope, get rectified.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline Ann

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  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Desperate for some help with my insurance
« Reply #5 on: November 27, 2013, 09:19:19 AM »
I am not an expert but, I don't think HIPAA precludes someone from asking the question -- it precludes them from sharing the info if the question is answered.  I would NOT answer, if asked.
It shouldn't matter what the med is or what it is for - if the contracted benefits company is not meeting the standards of the company, a complaint is in order and would, I hope, get rectified.

Mike

I should have been more clear - what I meant was that I don't think you would be required to answer the question - in other words, they can't force you to provide the information as it would be a breach of your medical confidentiality. I had a look at some of the info on HIPAA laws but I found them confusing. :-\

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/

edited to add...

hereinny, if you do get asked this question by the benefits manager, just tell him/her that what medications you take are irrelevant - they have been prescribed by a doctor and the prescription provider isn't delivering. It's as simple as that.
« Last Edit: November 27, 2013, 09:24:20 AM by Ann »
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline bocker3

  • Member
  • Posts: 3,391
  • You gotta enjoy life......
Re: Desperate for some help with my insurance
« Reply #6 on: November 27, 2013, 04:16:02 PM »
I should have been more clear - what I meant was that I don't think you would be required to answer the question - in other words, they can't force you to provide the information as it would be a breach of your medical confidentiality. I had a look at some of the info on HIPAA laws but I found them confusing. :-\

I knew what you meant -- I just didn't want someone else to start threatening somebody with a HIPAA violation if they were asked a question.

M
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

 


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