For the past 13 years I have dealt in some form or fashion with medical insurance companies on what I would loosely term, a "professional" basis. My work depends on knowing the systems they have in place to capture maximum reimbursement and maintain compliance.
Exciting shit, right there.
It makes dealing with insurance companies, like Coventry Healthcare of Nebraska, on a personal level that much more frustrating when I know I’m getting the shaft and there just seems to be no where to turn.
In April, we saw Dr. Hairy, the psychiatrist, who then prescribed the Vyvanse for Doodicus. With Coventry Healthcare of Nebraska, they required Dr Hairy to submit a pre-authorization before they would pay for the prescription, and at $230 out-of-pocket, I was thankful that the doctor informed me that he would take care of the auth.
That appointment was on a Thursday. I dropped off the script on Friday. On Monday, the pharmacy called me to let me know they hadn’t received the paperwork THEY needed, so they refaxed it to Dr. Hairy. By Wednesday, we were still without a prescription for Doodicus so I bucked it up and paid for it with the knowledge that once the pharmacy and the doctor and the insurance company, Coventry Healthcare of Nebraska, got their shit together, I would get a refund.
Days and days and days passed. On May 1st, we were covered by a new plan through our employer, who switched because they found out that the rumors about Coventry Healthcare of Nebraska were true: Coventry Healthcare of Nebraska sucks.
But still, I didn’t worry. The script was written prior to the termination. It was logged by the pharmacy prior to the termination. And it was initially received and subsequently denied prior to the termination of Coventry Healthcare of Nebraska. We were all just waiting for them to reprocess based on the auth Dr. Hairy, whose office I had communicated with several times in regards to the issue, had completed and faxed to Coventry Healthcare of Nebraska. But then word came from Dr. Hairy’s office that the auth hadn’t reached Coventry Healthcare of Nebraska until AFTER the termination date so they denied it.
I was furious. I made several phone calls, each one to Coventry Healthcare of Nebraska more frustrating and helpless than the last. I was told several times over that it didn’t matter when my doctor wrote the prescription, their benefits would be determined by when THEY received it. I asked what would happen if a patient was given a prescription on a Friday afternoon and the earliest office hours the doctor had was Monday and that the policy was terminated sometime on the weekend. They said they wouldn’t cover it.
Even though the patient, the policy holder, the premium payer, could no more control the situation than he could control the phases of the moon, he was the one getting fucked over. Fucked over by Coventry Healthcare of Nebraska and their unjust and unreasonable policy.
Maybe Dr. Hairy didn’t send it in until after my termination date, but it shouldn’t matter one iota. The script was written under policy coverage, therefore Coventry Healthcare of Nebraska should by all accounts covered those orders. The appeals process has dried up because while Dr. Hairy has proof that he faxed the auth prior to the termination date, Coventry Healthcare of Nebraska states that according to their documents, they did not record the receipt of the fax until after the term date.
What else can I say, but to conclude, You Suck Acne-Poxed & Hemorrhoid-Infused Ass, Coventry Healthcare of Nebraska. Our corporation is sooooo much better off without you.