TTSOML #155: Dr. Said and Insurance Problem Investigation

In my last post I wrote how I went to the pharmacy, which was Walgreens, to fill my prescriptions from Dr. Said, and I was told I couldn't have it filled because the insurance company cut me off (without giving me the legally required 30-day notice).

So, after having me on daily narcotics and medications, for several months, I was being told I would have nothing (which would have put me in severe withdrawals and pain besides).

The pharmacist looked like he enjoyed telling me this. I drove to my grandparents house where they paid for it out of pocket so I could get it filled and the guy wasn't happy when I came back. But he gave me my prescription.

Then, I had to fill out a complaint to the state insurance HMO (Molina) and remind them they had a legal obligation to give me notice prior to making changes to their decisions in what they cover.

I went back to Walgreens to find out what had happened,and another pharmacist looked up some information and said it appeared one of the pharmacists there had tried to red flag me to the insurance. He had entered in billing several times, which would alert them to look at the prescription more closely. A doctor from CWH ER had written a prescription for me for something which was extremely expensive. It was some kind of anti-nausea medication and I was told he would have known it wasn't covered, that no insurance covered this. Then the pharmacist entered it into the system several times, even though I had told him I didn't want it afterall when I got to the window. He kept entering it. And this caused someone to make a phone call I think.

I wanted to know why my prescription was cut off abruptly and no one would tell me. I was told to call the third party that acts as intermediary between the pharmacies and the insurance company when prescriptions are called in.

I called the group but no one could give me information. They told me I had to be a doctor to get the reasons why, even though they said they did have some information on me. They told me, I was red flagged as being drug seeking. I said, who said this, and they said they couldn't tell me. I asked a pharmacist from Walgreens to call and she got the exact same message, that I had been red flagged as drug seeking. I blew up, because my prescriptions were from a doctor, and they were necessary and I wanted to know who had attempted to cut me off from needed medications WITHOUT WARNING or NOTICE.

Then, when I called Molina or the state insurance, they quickly denied this. So I decided to find out for myself. I called the intermediary group which got their orders from insurance companies, and the only way to get through was to dial an access code number, which every doctor or pharmacist had and could use. Of course, I wasn't either. But I made a very lucky guess on the second or third try...

The first time I punched in a series of numbers, I did it randomly. Then I prayed. I prayed God would help me to punch in a number that worked. So I punched numbers again, randomly, and I can't remember, but it was at least a 7-10 digit number that was required. On the second or third try, I was in. I had randomly punched in a number that gave me access to the system.

I pretended to be a doctor and asked about patient (me). The guy on the other end gave me the information. I HAD been blacklisted and red flagged, and the insurance company had lied and said it was because my PCP wasn't covered under their insurance so neither was the prescription (which wasn't their policy and wasn't true).

Then, I admitted to the guy, that I was not actually a doctor. I felt a little guilt I guess, and explained what had been happening. He asked how in the world I was able to get through and I told him I had just randomly dialed a number. I don't even know, to this day, whose access number I dialed. But I got through. He was sympathetic and said it was strange, because they did show multiple attempts to push a prescription through that most doctors would know was too expensive and so would draw attention to my account. He said it was odd. I got his name and number (though I'm not sure where it is now) and asked if he would be willing to repeat what information he had if I needed him to. He said yes, and I also asked him to please make a copy and save it himself because I felt the information in the system could change.

My point, was that I was being routinely blacklisted by Wenatchee doctors and medical professionals, state-wide, to other clinics, insurance companies, pharmacies, you-name-it. Not only that, I had proof some people in Molina were in on it, because otherwise why would they feel the need to lie?

They eventually admitted they were wrong to cut off my prescription, but only after I called an advisory board and a governor or some kind of authority, and after they were contacted by this agency, THEN, and ONLY THEN, did they back down, and admit what they had done was illegal, or at least give 30 days, even though they still lied about their reasons for cutting me off.