Thursday, May 30, 2013

Day 30 - Frustration Galore! Can't pharmacies and insurance Companies just get along?

First's outfit #30 :)

I did reuse the shirt, but it is a new outfit :) in case you've been keeping track, lol...Red Two took the picture, which is why the angle is so bad...haha!

Had a busy but nice time last night. Not only was it David's birthday, but the older two girls had their spring concert at, my mom was supposed to fly in late that night. Needless to say, I was running around like crazy. Grocery shopping, baking, cleaning, cooking...

We had ribeyes, twice-baked potatoes (Pioneer Woman's recipe) and corn casserole. I decided to make a melted ice cream cake...even though we are having his actual birthday party on the weekend with family, you can't have a birthday and not have cake and, more importantly for David, ice cream. It's this cool recipe where you pair any box cake mix with a pint of any flavor ice cream (melted) for the liquid, and then a glaze on top. I thought it was a pretty cool idea. I wound up going with an orange cake and vanilla ice cream. David always has liked orange cream stuff. It came out pretty good!

Anyway, we had an early dinner, then the girls had their concert at school. It was the worst time ever! The concert was at 6:00 and they had to be there at 5:30. Seriously! it couldn't be 7:00? or even 6:30? They did a great job though! Red One is in 5th grade, so she was in the 5th grade chorus, and she also plays the viola. Red Two plays the flute. 

After the concert we headed back to the house for cake and ice cream. Poor Buddy had conked out at the concert. I tried to wake him up so he wouldn't miss out on the cake...uh uh! He was done for. He perked up for a minute when I gave him some ice cream, but it didn't last long. He laid right back down on the bench ;)

David loved his presents! He knew I was getting him new shoes...he'd figured that one out. He has a pair of Merrell barefoot style shoes that he wears constantly when he's not working. He's actually worn holes in the material on top from wearing them so much. So he guessed that one pretty quickly. He did not, however, cheat and check Amazon to see what I got him, so the new set of really nice clippers was a surprise. He'd really been wanting some, so he liked that!

After that, my mom was supposed to fly in, but her flight was delayed due to bad weather...she finally made it in today at noon. She'd been awake for 30 hours :/ Hopefully she'll get a good night's rest tonight!

So today...getting down to the frustration that you are all so curious about; I spent the majority (at least it felt like it) of the day on the phone with the insurance company and the pharmacy trying to get David's medication filled so he can start his next round of chemo. It's been an absolute nightmare! I think I mentioned it a few posts back, but this one medication (the chemo he's on is a cocktail of three different chemos) is only available from one pharmacy and our insurance requires that all refills be processed by their mail order department. They had been giving us overrides, but the last time said no more, it had to go through them. So now I've been trying to get them to mail it...just seriously so frustrating! Everyone I talked to was really nice...they were trying to be helpful and do what they could...just wish there was an easier process! 

I started off by contacting Caremark to see if they were able to process the mail order that had been called in two days ago. A very nice gentleman was helping me, but I was on the phone for about an hour that time. What's crazy is his wife had actually gone through the exact same PCV chemo's not that common anymore. I think that helped him want to help me more. He talked to his supervisor and was finally able to get me one last override code. He saw the order in the system, but couldn't access the details. He said that he recommended using the override code for Accredo, the other pharmacy, so we could go ahead and get the medicine sent as soon as possible. The only drawback was the code was only good for today, so it had to be submitted by Accredo to Caremark today. He also told me in the future that it needed to be a 90 day supply prescription...which is crazy in itself, they don't give out chemo in 90 day's constantly being reevaluated...and then they would process the order and hopefully be able to fill it. I have my doubts. But if it was not a 90 day supply, it would automatically be rejected. There just doesn't seem to be any common sense override in the systems. 

After I got off the phone with Caremark, I called Accredo asking them to send through the order today, as it was only good for then. The representative there was very helpful and set up the delivery for next Wednesday, the earliest time she could. I asked when we would know of the override actually worked. She said it would typically be about an hour...but they would call me if there were any issues. 

I was hopeful, but planned on calling them myself to verify, especially since the authorization had a limited time frame. My mom flew in and Buddy and I picked her up. He's been talking about her coming for a few days now, so he was happy to see her!

When a couple hours had passed, I called Accredo back to see if there had been any problems with the order. That time, the representative said the only thing she saw in my notes was that it needed to be mail ordered, so had been rejected! I'm so ridiculously upset at this point! I try calling Caremark right away, I get transferred to whoever can help me and what happens? Her system locks up, it's updating, can you call back later? What?!?!?!?! I'm on a time limit here, you know....but nothing I can do. I try calling the doctor's office to update them and see if there's anything they can do, but I never get a call back. The one nurse who is so great and always helps, was out for the last couple days, but nobody else helped me. 

Now it's time to pick up the girls from school. Homework, projects, chores, dinner...I call Caremark back around 5:00...surely someone can help me this time! The rep I talked to this time said there's no record that Accredo submitted anything to them today. The last time Accredo tried was on the 24th...not today! She suggested I call them with her on the nice. I get David's phone and call Accredo to find out why I was told it was rejected and it hadn't even been submitted. Unfortunately, right as soon as I get someone from Accredo, I accidentally hang up on Caremark...UGH! Oh well, keep going...I tell her what Caremark told me, it was never submitted. She's trying to find out what's going on, had it been submitted or not. She said she needs to call another department to find out some stuff and see what's going on...can she call me back. Okaaayyyy....sigh

Dinner...I'm so fried at this point I can't even cook. Grilled cheese was sounding too hard. I finally threw on a pot of water for spaghetti, crack open a can of marinara, dump it on, voila! I did have a loaf of French bread that I put some Fontina and butter on and heated up...that was good! 

No I call back...again. Different rep, not sure, checking, I'm showing that it will be delivered tomorrow. Wha....??? I'm happy but confused. Then the lady I had talked to earlier called me, said it went through, delivery is scheduled for tomorrow...Hooray!!! Thank you, thank you, thank you! Other than the nagging sensation of I'll believe it when I see it, hopefully that is that! Until next round anyways. 

The End.

Oh wait, no it's not...then we had to scoot to the girls basketball game. Yay...they lost, oh well...

Now it's over. Where's my bed again?