Specialty Medication: the Saga Strikes Back
A week or so ago, we received an unexpected package in the mail. It was from the Leukemia & Lymphoma Society (LLS), welcoming Lut to the grant program.
Me: “Huh. Well, that’s nice, I can use it to pay his health insurance premiums if I can get sufficient proof of payment in a form I can submit to them. Maybe Accredo billed LLS and that’s how Accredo covered the copay? I never did find out who made the copay in August.”
The next day, LLS sent us a pharmacy card: “Present this to your pharmacy or specialty pharmacy and we’ll pay claims directly, so you don’t have to submit a reimbursement form.”
Me: “We’re at out-of-pocket cap now but that may be useful next year.”
Wednesday, we went to the oncologist. He is happy with how Lut is doing on the current dosages, and said he’d be sending in refills.
This morning, the phone rang.
Accredo bot: "We are calling with refill information!" confirms identity
Accredo bot: "Please hold while we connect you with a person."
Accredo hold message: "We are experiencing higher-than-usual call volumes"
Me: "YOU CALLED ME."
Me: "Why did you call me to put me through to a person when you DO NOT HAVE ANY PEOPLE."
Technically, this isn't worse than CVS Specialty Pharmacy, which often didn’t inform me that the refill had gone through at all. So I’d just have to remember to call them a few days after the clinic said they’d sent it, and hope for the best.
But I do feel like Accredo could wait to dispatch their bots to call me until they were at, like, normal call volumes. -_-
As it turned out, it only took a few minutes to connect me to a rep, Tammy.
Tammy with Accredo: "So there's $0 copay on the Revlimid."
Me: "Right."
Tammy : "And $7500 copay on the Ninlaro."
Me: "..."
Me: "ARE YOU FREAKING KIDDING ME."
Tammy: "...no?"
Me: checks Cigna's website "Who do you show paid for the prescriptions we got last month?"
Tammy: "Cigna."
Me: "Cigna has forgotten this."
Tammy: "Ooh. Guess you need to call Cigna."
Me: dies
Tammy: “Do you want to schedule the Revlimid delivery, since there’s no copay on that?”
Me: “Yes pls.”
The Revlimid is the important one of the pair. We have a leftover dose of Ninlaro, so Lut can start it on time even if Ninlaro takes an extra week or two to receive (he’s supposed to start next Thursday).
Me: schedules Revlimid delivery
Me: sighs
Me: calls Cigna
Cigna: "We show the only order was on 9/8/2021."
Me: "We received a shipment of $21000 worth of medications 3 weeks ago. Accredo says you paid for it."
Cigna: "Oh, that was reversed out. We didn't pay for it."
Me: "... Accredo shipped it. Are you saying they sent us $21,000 in medication for free, out of the goodness of their heart?"
Cigna: "Yup! We didn't pay for it. Do you want me to call Accredo?"
Me: "... sure. why not."
Cigna: connects me with Katarina at Accredo, instantly hangs up because Cigna rep don’t care
Katarina with Accredo: "So this is about the delivery from August 16?"
Me: "Sounds right."
Katarina: "We show your insurer paid it in full."
Me: "Which insurer? We have two. Cigna and Medicaid."
Katarina: "Cigna."
Me: "Who paid the co-pay?"
Katarina: "There wasn't one. Cigna paid for both in full for $9k-ish"
Me: “None of this makes sense. Can you verify it?”
Katarina: puts me on hold a few times while she talks to various people and checks systems “Everything we have says Cigna paid it in full.”
Me: "Can you call Cigna and convince them that they paid for it? Because I can't. I don't have any proof that you billed them."
Katarina: doomed voice "I can try..."
Me: waits on hold
Katarina: waits on hold
Katarina, after several minutes on hold: "I'm sorry, I can't reach Cigna."
Me: "Well, it looks like no one paid the co-pay last month, and you did get Lut into the LLS grant program. So maybe just put me through to billing and I'll pay for it with the grant now?"
Katarina: "...sure."
~
Lyn with Accredo Billing: "I don't show a balance?"
Me: "... Really?"
Lyn: "Let me check some more."
Lyn: "Nope, no balance."
Me: "Did the Ninlaro and Revlimid both ship?"
Lyn: checks "Yes. I show Medicaid paid for it in full."
Me: "OKAY THEN."
A few minutes later:
Email from Accredo: “We scheduled a delivery for tomorrow! Check our website for details.”
Accredo website: “We’re shipping Revlimid on Saturday. Please call to schedule the Ninlaro delivery. Your account balance is $0.”
Me: “Welp.”
My guess at this point is that Lyn was wrong about Medicaid paying for anything, and wrong about Ninlaro having shipped. Instead, someone in refills has to press a button saying “we’re charging for the Ninlaro now.” And only after that step can they transfer me through to billing to pay it. And then billing has to transfer me back to refills to actually ship it. That feels like the Accredo Way.
But I have two weeks to get the Ninlaro refill and I’ve spent over an hour on the phone with these clowns already. I’ll wait until tomorrow to see whether we get 0, 1 or 2 prescriptions, and then call on Monday to sort it out if the number of prescriptions received is less than 2. -_-
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