On my third try of the week, I finally reached a human being in the grievance department of Anthem Blue Cross. While the new medication that Sophie is on has been approved by the insurance company, it is not on the formulary (spell-check does not recognize this word which leads me to believe that it's bullshit), so we must continue to pay 50% of the cost of the drug. How and why the insurance company decides what drugs go on the formulary (formulaic, formulated, formidable, formatively) is dark territory indeed, and after today's conversation, I am no closer to understanding anything. I remained civil -- in words, not in thoughts -- and impressed upon the agent how important this was to us and that I found the arbitrariness of the decision hard to understand but she only stated over and over I understand your frustration ma'am, but the grievance department can only make these decisions and you can't speak directly to the grievance department but must wait for their decision and they have thirty days but I can tell you that you will not succeed because you can't just put drugs on the formulary.
Remember the movie Brazil?
Terry Gilliam, the creator and director of the movie said I've always had a great distaste for authority and bureaucracy and all the additives that they breed.
I suppose I will continue to find my solace in poetry.
The whole thing sounds totally sci-fi. Grievance department, formulary, 30 days, I'm sorry but it won't happen. It's like you're stuck in some Twilight Zone episode, where the world has tilted in the wrong direction just enough to lend itself to confusion and chaos, yet still look the same on the outside.ReplyDelete
Funny, we were just discussing "Brazil" last night. Sounds like you've been living it.ReplyDelete
Formulary This, MF'ers!ReplyDelete
Well, find your solace where you can and know we are gritting our teeth with you.
Is it not so very frustrating that you can't speak to the grievance department?So wrong on so many levels.ReplyDelete
Our oldest had a decline of a hip surgery,due to the "experimental" nature and I could not believe that we were not allowed to speak to the people who did the declining.I picture them holed up in some dark office,with this giant red stamp,ripping through file after file,arbitrarily,sending out decline after decline.Of course we can appeal through the State of California ... yeah,right,that will work.
As for the drugs.I swear I have lost track of what is name,generic,formulary coverage.Zoey's Medical,use to cover brand only,then they didn't,now they do.Cannot for the life of me keep up with it.
I'm opting for the bullshit theory.
I asked my husband how drugs get into a formulary. He said: The drug cannot be investigational. It's also based on what drugs are in the same therapeutic category that are just as effective and are cheaper. It also depends on whether there is a generic available. Also the drug has to be available at a reasonable cost from the drug company. I asked if there was a "master" formulary. Nope, each insurance co. has their own but, apparently, the determination as to what goes on it is the same. Just a little more frustrating information!!ReplyDelete
I dealt with a minor glitch in with a prescription cost last week, a miscommunication , a random obviously not meant for us voice mail.. all because I ventured in .ReplyDelete
It's a world I avoid , in truth, because , well it is not a real world at all.
bless you in every moment of this. every phone call, and form and interaction, human or not.
So who does put drugs on the formulary? What is the process?ReplyDelete