Lately it seems like everyone has been complaining about medical insurance, and how patients like me consistently get left by the wayside and are forced to suffer.  Cost is now the defining factor for whether or not a medicine or procedure gets approved for payment.  Fortunately, I had been spared from the worst of it as of late, but a few days ago my two-year lucky streak came to an end, and now the sign in my room reads “03 days since the last insurance debacle.”

drugpreauthorizationAs I descended in to the labyrinthine depths of insurance bureaucracy this past weekend, I knew it was going to be an adventure worthy of Indiana Jones, or, maybe his brother, Sidney Jones, certified public accountant.  Let me set the scene for you – it was a Thursday afternoon, and I had just returned home from my Grandmother’s internment ceremony.  She was 97 years old and had been suffering for two years.  After she attended my wedding, I think she realized it was her time to move on, so she did.  While not completely distraught, I’m sure you can imagine that the last thing I wanted to do after a day-long memorial was deal with my insurance carrier.  Like a condemned prisoner though, I dialed the customer service line and prepared for the Chernobyl-level ineptitude for which I was certainly in-store.

Because I take Kineret, I need an injection every day, and my doctor only writes me enough shots for a month at a time.  So, like a good little patient, I called my insurance carrier on Monday to give them the three days they apparently need to find my shots and put them in a box for shipping.  With my Grandmother passing on Tuesday night, I forgot about the shots completely until Thursday came and I realized that I had just three syringes left. I knew there was no way I would make it through the weekend until Monday, and then I realized I should have heard from my insurance company by then with shipping confirmation.  So, as I was in the limousine, heading to the cemetery for my Grandmother’s internment, I called to find out just what was going on.

I dialed the number and asked for hieroglyphics as my native tongue, cleverly sidestepping the robot guardian who shields the human beings at the call center from actual work.  I eventually reached an agent who was obviously thrilled with my ingenious hieroglyphics ruse, and I asked for an update.  After several tense minutes wondering who was going to win the race between the commencement of my Grandmother’s ceremony and the insurance agent giving me the info I needed, I was finally told that even though I had a valid refill, I needed my yearly pre-authorization from the doctor.

Normally, I’d have asked why no one at the insurance carrier bothered to inform me the authorization was expired, and inquire if they actually did want me to keel over, but I was playing beat the clock, so I had to forgo the usual questions you shouldn’t have to ask.  I immediately called my doctor and, much to my chagrin, neither the doctor nor his usual secretary was in the office.  I had to deal with a temporary replacement, and ignoring the obvious harbinger of doom she represented, I went ahead and explained how to fill out the form and fax it back to my insurance company so I could get my shots shipped out as soon as possible.  She genuinely seemed to know what I was talking about, so I thanked her and hung up, cautiously optimistic that my medicine would get delivered before I capsized with a raging fever and glands like a bullfrog in heat.  Of course, I should have realized that prematurely feeling happiness for the completion of my task would result in karma mounting me from behind, but I’m an optimist at heart, what can I say?

The real fun began when I got home at 4pm later that day, and called for an update again.  After several epochs on hold, the “conversation” morphed into a surreal exchange where logic and foundation evaporated and I became trapped in a Gordian Knot of language.  Here is an excerpt (the agent is in italics).

“Ah yes, It says here that your drug pre-authorization has been denied.”

“Denied? That seems odd, considering I’ve been getting this medication from you for several years now.”

“Yes, it says here the Kineret was denied because you need to try Humira or Enbrel first.”

“I was on those medications for years already.  You guys have my medical records.”

“The authorization the doctor just sent doesn’t say you tried those medications first.”

“Yes, but you have my medical records, plus all the other authorizations that say I did try them first.  It’s obviously an oversight, and besides, it doesn’t say I didn’t take them either.” (It seems this bit of logic caused some sort of mini-stroke, because from here on in, it gets much worse).

“Well, uh, it doesn’t matter, it doesn’t say you tried them first so it was denied.”

“Fine then, I’ll have the doctor send another authorization.”

“No, you can’t do that, now you have to appeal the decision.”

“Wait, I don’t understand.  I have been on this medication, from you, for years, and now you are telling me I have to file an appeal to get the medication from you, the medication I have been on for years, the medication that you have a valid refill script for, and that you filled the first two refills of.  Just check your own records, this is absurd.”

“I’m sorry Sir but we aren’t allowed to look back.”

“You aren’t allowed to look at old records? Then why do you keep records at all?  If the only way to view something from the past is to actually build a time machine and go TO the past, then what’s the point of keeping anything?  Besides, an appeal will take weeks, I run out of this medication tomorrow.”

“Well, even if I was able to look back I wouldn’t be able to go by an old document, only the last one sent counts.”

“Yes, but don’t you understand, no matter what the latest authorization says, it doesn’t make me un-take the medication that I’ve already taken years ago.  This isn’t the Butterfly Effect.”

“You need to request an urgent appeal which will be completed within 72 hours.”

“Yes, but even 72 hours means I will run out of medication because today is Thursday and you guys don’t ship medicine on Sunday.  Oh, also, you have all the documentation you need to see that I’ve been getting this medication from you, for years, without any issues.  Is there someone I can talk to there who has basic deductive reasoning skills?  You know, cause, effect, if, then?”

At this point the woman’s head exploded and I was transferred to three different departments, all giving me different solutions, before I was finally transferred back to the first department again and I died a little inside.  I eventually realized I’d have to suck it up while they went through the urgent appeals process, so I loaded up on steroids and made it until Monday when my refills arrived.

I’d love to tell you that this was an isolated incident, but it isn’t.  In my almost thirty years of disease, I have had conversations that, believe it or not, are several magnitudes of absurdity worse than this one.  The state of medical insurance in this country for chronically ill individuals is abysmal, and it needs to change.  If you can get someone on the phone to help you, that is.