Insurance Company Woes

Ridiculously messed up. That's the only way I can nicely describe the people working at Anthem Blue Cross/Blue Shield. I have been dealing with different representatives via phone for the past week. Each representative has told me a different process for receiving my Enbrel (my psoriatic arthritis medication). I documented everything each Anthem representative told me. I can't even begin to describe the conflicting information they have given me. Here are just few examples:

  1. I was first told that I could get my Enbrel at a retail pharmacy (like Walgreens or CVS) as a 28-day supply for $100 per month. About 1 month later, a representative at Anthem told me my plan would allow me to get a 90-day supply for $100. When I asked if it would have to be done through mail-order, I was told that my plan would allow me to do a 90-day supply through mail-order or a retail pharmacy. That sounded great to me. I asked the representative to explain the process. When finished, I had my dermatologist write a prescription for a 90-day supply through my retail pharmacy. The dermatologist even confirmed it with Anthem and the retail pharmacy to make sure it could be done.

  2. I went to pick up my 90-day supply from the retail pharmacy yesterday. The pharmacy told me that Anthem would only allow me to get a 28-day supply. I immediately called Anthem and spoke with another representative who told me I had to get prior approval. I had already done that when I first was prescribed Enbrel. Then, the lady told me that a 90-day supply would cost $40. I told her that the other representative said it would be $100. Then I asked her to tell me how much I'm paying now for a 28-day supply. She told me I was paying $20 for a 28-day supply. I told her she has the wrong information and demanded to speak with her superior. The representative then hung-up on me!!

  3. After speaking with four more different representatives regarding my prescription, I'm still being told that I can only get a 28-day supply from the retail pharmacy. (I would go into more detail with the other conversations I had with various Anthem representatives, but that would mean describing a total of more than 4 hours of conversations with representatives and their superiors!) To make matters worse, I have filed three formal complaints with Anthem which they have thoughtlessly neglected to follow-up. I still have not heard a clear, understandable explanation from anyone at Anthem regarding my case.
Here's the "icing on the cake". Anthem will not allow my retail pharmacy to refill my 28-day prescription until 3 days before I need another injection from the refill. Then, it takes 2-3 days for the retail pharmacy to order the prescription. That means I can't pick up my medication until the day before or the day of my injection! How inconsiderate and ridiculous. So here's my take on insurance companies, in general: They're money-hording companies that have no consideration for their clients and are so full of red tape that nothing is done right to assist patients in need.

Some may disagree with me, but that's why I call this type of post "my perspective". Say what you like, but when it comes to treating individuals with psoriasis or psoriatic arthritis, insurance companies, especially Anthem, receive a big fat F in my grade book.