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Insurance, Skin-Prep Wipes, and Principle (Part 2)
March 26, 2009
Allow me to continue last week’s drawn-out retelling of "Four Weeks, Fifty Phone Calls: What I Did For A $17 Box of Skin-Prep Wipes."
It’s been a week now since I wrote Part 1 of this blog entry, and in the time between the writing, some of the ire I felt after a two-month runaround has subsided. However, at the end of this piece you’ll read about two new issues that have come to light in the past week to ensure that there will be no shortage of difficulties with insurance providers, durable medical equipment suppliers, or pharmacies any time in the near future.
Let me introduce you to a few of the players in this ordeal:
I wish you luck if you so choose to wade through the muck that’s about to follow. (I’m warning you ahead of time that it’s fragmented and somewhat difficult to follow — maybe. Imagine trying to watch three or four tennis matches at once.)
When I last left off, I’d received my shipment of diabetes supplies for my insulin pump from my current durable medical equipment provider (DMEP), Edgepark Medical Supplies. Edgepark failed to send me the protective barrier wipes (PBWs); they’d been sending these to me in all prior quarterly shipments, but now they ceased sending.
When I called to ask Edgepark if they could please send some to me, they said they couldn’t: PBWs weren’t covered in their contract with my insurance company, so I’d have to call my insurance provider.
My insurance provider. That’s Blue Cross — also referred to as Blue Care Network (BCN).
I called BCN and explained what happened. BCN tells me I need to call Northwood.
I call Northwood. I give them the same story I just relayed to BCN.
Northwood tells me this shouldn’t have happened. The woman I speak with at Northwood (and by the way, the people at Northwood are friendly and do their best to expedite things) tells me she’ll call someone at Edgepark and get it straightened out.
This was in early February. I didn’t hear back from Northwood.
I also never received my PBWs.
A week later, I get a call from Edgepark: PBWs are not covered under their contract with Northwood.
So, Edgepark says, they can ship PBWs to me, but they’ll have to bill me for them. How does that sound?
That doesn’t sound acceptable, I tell them.
So, No, I say. I tell them I spoke with Northwood. Northwood told me they talked with you and cleared it up.
Well, says Edgepark, you’ll have to call them back.
At this point Northwood explains something to me about the medical contract (I zone out and don’t pay too much attention to this information — not my job to care). Northwood apologizes. They tell me my PBWs can instead be sent from MedEquip.
Great, I say. What do I have to do?
(And understand, reader, by this time I’m invested in seeing how far I do have to go in this ludicrous bureaucratic bit of Ping-Pong to get a cheap box of protective barrier wipes.)
Northwood gives me MedEquip’s number.
I call MedEquip. They say they need prescriptions for the PBWs, as well as for the replacement lancet device that I decided to request as well (the cover on my Accu-Check Multiclix lancet cracked).
I call my doctor’s office and ask if they can fax the scrips over to MedEquip. Please put “Attn: Team 2″ on the fax, I say.
Mid-to-late February. I’ve received nothing in the mail. I’ve also received zero phone calls from any of the players to let me know that something isn’t happening because of x or y. I’m in limbo.
I call my doctor. Or, more precisely, his nurse. (I was in the process of getting my prescriptions transferred over to Walgreen’s mail order [see "Switching Pharmacies Is Hard on the Heart"], so I needed to be on the phone with them for that little travail, because that, too, wasn’t going smoothly).
I ask the nurse about the prescriptions.
Hmmm…Those didn’t seem to get faxed over, says the nurse. Let me do that for you now.
Will you? Thanks.
The next day, MedEquip calls. Hi, they can’t provide me with the PBWs because — get this — I don’t have a contract with MedEquip for all of my durable medical equipment. I don’t have my contract with them?
The way this is explained to me, after phone calls with Northwood, is that because I’m getting the bulk of my equipment from Edgepark, MedEquip may not want to honor the one-time fulfillment of PBWs.
Further, although MedEquip told me they could get me the replacement lancet device, they’re now telling me they can’t. (Although it turns out I could just call the manufacturer and request a new one, free of charge. That job: done.)
I call Northwood. The person I speak with regarding my PBWs, after I explain what’s going on, says she’ll call Edgepark and work it out so that they get reimbursed for sending me the PBWs, that I should have them soon, that we can get this cleared up.
End of story, right? Not quite.
A week later I get a package in the mail from Edgepark. Barrier wipes! Yay!
No. I open it, and inside are, loosely packed (not in a box), about 50 alcohol prep wipes. Umm. Not the same thing. I needed protective barrier wipes.
I call Northwood. Run through the whole thing. Ask what’s going on. They say they’ll call Edgepark.
Ten minutes later, I get a call from Edgepark. What was sent to me? I tell the guy that it was a hodgepodge of alcohol prep wipes.
Oh. He tells me it was because the PBWs weren’t covered and that they were just sending me samples, but the guy must have put in the wrong samples.
But I’m also confused. Northwood told me they were covering those PBWs.
No, says Edgepark guy. It seems that’s not going to happen.
I call Northwood. Rehash.
Northwood now tells me they’ll call MedEquip and have a box of protective barrier wipes shipped to me regardless of the contract status and who it is I get the bulk of my medical equipment supplies from.
Oh, and by the way, says Northwood, effective May 1 you’ll be transitioning from Edgepark to MedEquip for all of your durable medical equipment.
Northwood is shifting their Premiere Care patients to MedEquip.
My heart sinks. Seriously? Do you have any idea the difficulty I had making the transition from my previous durable medical equipment provider to Edgepark? It took months to get things ironed out!
I just sigh, say thanks, hang up the phone.
Two days later I get my PBWs, but there’s no cause to celebrate. I know the trials and tribulations to follow.
Then, yesterday, I learn that Smiths Medical, the maker of my insulin pump — the Deltec Cozmo — is discontinuing selling the pump and diabetes supplies.
Just joy. Sheer joy. And despite the promise of smooth transitions to whatever is next, so
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