Sunday, April 15, 2007

A Kreng Jai Challenge....

In getting ready for my surgical appointment on Monday, I had to get a few prescriptions. Nothing serious, just little things that will make it easier for the surgeon to poke my eyeball and do his magic.

I went into Target and found out that my Medicare card doesn't match my Blue Cross RX Gold card.


The plan I chose for my "Part D" coverage is the Blue Cross RX Gold plan which is supposed to guarantee me a co-pay of $3.10 on any and all prescriptions.

Here's the Cliff Notes of how that came to be. After this, I'll get to the point of this rambling.

Medicare notified Blue Cross that they (BC) will be responsible for my Part D coverage as I am a low-income recipient of benefits. The "Gold" part of the plan was of my choosing. I pay a small premium for the upgrade. It includes more drugs in the formulary than the basic plan and the co-pay is considerably lower. I didn't get to choose the insurance company (basically a third party administrator for Medicare ~ confused yet?) that would provide my coverage.

Somewhere between Medicare and Blue Cross, someone didn't update a database so I was not "in the system". (If I ever hear that phrase again, I'm going to vomit!) When the pharmacist went to submit my claim, it came back as my not having any Part D coverage. The pharmacist told me that I would have to pay cash for the antibiotic eyedrops because of this error. He told me to call Medicare.

I should have known! Get on the bus to Call Center Hell.

Medicare told me to call Blue Cross. Blue Cross told me to call Medicare. Medicare volleyed me back to Blue Cross ~ and on we go. I spent 5.5 hours Friday afternoon on the phone.

Finally I got a supervisor at Medicare who made a few phone calls to Blue Cross on her own. "After all, we have a bigger bat," she said.

Well... ermm... yeah. Okay. After 5.5 hours on the phone, she could have told me she had a hotline to Jesus Christ and I would have believed her.

As a result of her conversation with BC, the problem was to be fixed by 1.00 PM on Saturday. I was given a tracking number and supposedly "inside" phone number.

The "inside phone number" was just the Customer Service line and none of the representatives knew what to do with the Help Desk tracking number.

How hard can it be to update a freaking database? It's not that bloody complicated! It's one command on a command line after a search through the beneficiary archives!

Looking at yet another marathon of phone calls, I lost it.

Just plain lost it. My housemates heard me and came to find out what was wrong. I don't think they've ever heard me yell before.

While managing to make it clear to the representative that I was not angry at her but at the situation, I let loose with some invective that would have put Howard Stern to shame. I managed to avoid the f-bomb but make no claims beyond that.

I'm hardly proud of it. It wasn't funny or cute. It was hurtful and damaging to the woman on the other end of the phone who had to hear it. For that part, I am truly sorry. I am ashamed by my lack of self-control and make no excuses because there are none, particularly for one who gives plenty of lip-service to traditional Thai values.

What I am not sorry for is that if my conversations with more than twenty people will cause Blue Cross to take a look at what falls through the cracks and the larger implications, my frustration was worth it. If I had been someone who needed ~ say, heart medication or something else life-sustaining rather than just some stupid antibiotic eye drops, I could be dead this morning. If I'd been someone who required medication for a child, that child could be dead or seriously ill.

There is absolutely no excuse for these kinds of errors.

I ended up paying cash for the eye drops. What if I hadn't had the money?




Anvilcloud said...

I think most of would have lost by then. What a nightmare.

Pam said...

Dealing with Medicare is like spiraling into hell, only to get transferred.

slouching mom said...

God, does THAT sound familiar.

Not being in the system. The kiss of death.

Lucia said...

How did we get HERE in the world? It's too much for most people...impersonal, crazy, unproductive.

KGMom said...

I so agree with Lucia--how did we get here. I have heard the Princeton medical economist Uew Rinehardt speak, and he says--if we were going to build a medical insurance system we would NOT build what we have. Then why doesn't we all DEMAND that it be fixed? Because, even if we did, big business (read the drug companies, organized medicine) would run to the legislature and cry foul.
Chani, so sorry you are on the receiving end of such nonsense. I pray your surgery goes flawlessly.

patches said...

Sorry, you had to experience any of the ineffectual hoop jumping you described. I only wish I could say, I'm surprised it happened..... That seems to be the only way bureaucracies provide customer service, and now the private sector often follows in their footsteps.

flutter said...

There is absolutely nothing worse than a phone tree from hell, only to be given to someone who can't help you.
I'm just so sorry you had to deal with it.

meno said...

No jury would convict you, particularily a jury of your peers.

heartinsanfrancisco said...

These morons make unhelpful their personal mission statement.

I subscribed to a Medicare drug program, which cost only $11.25/month last year plus about $3 for my one medication. This year it jumped to $34.22, plus 12 for the drug, which has an uninsured street value of about $5. I cannot get out of the program until November, and every month it irks me to have to pay this.

The last customer disservice person I spoke with listened as I explained the math of it, and I asked her if she would choose to pay $41.22 every month when I could pay $5. w/o their program for this drug.

She said "I don't know." And I lost it, too.

Good luck with your surgery, Chani, and a quick recovery.

Sevenwinds said...

I hate to admit it, but I used to build call centers before my retirement in 2001 (the technology parts only). The people who answer the phones are pretty much limited to what the scripts and the system will allow them to do, nothing else. They are usually low paid people who can barely read a script properly or know how to handle the variety of calls that might come in without some kind of job aid. The job aids are developed by people who think they have anticipated every possible scenario...well that seldom happens and many calls just 'fall thru the crack'.

The best way to solve any kind of call center issue is to immediately ask for the floor supervisor if the agent says they cannot help you. Be persistent, and don't let them brush you off with a 'callback from the supervisor' response. Once you get the supervisor, get his/her name, location, and the shift they work on. On any followup, ask for the person you last talked to. Most call centers handle a variety of calls from all over the world on a 24 hour and day basis and can have as many as 2000 agents. They may even be handling calls for washing machines on one call and then cereal refunds on the next. Its no wonder that people either are very unhappy with the service or get caught in what we used to call IVR (interactive voice response) limbo.

Hang in there and good luck tomorrow.

Suzy said...

When I was a kid we had a record of a Mike Nichols and Elaine May routine where she was a telephone operator and he was a guy who had just had his last dime eaten by the phone. It seemed hysterically funny, but I would always have this knot of tension in my stomach even as I laughed, because deep down I knew that the situation was incredibly frustrating and I MIGHT EXPERIENCE SOMETHING LIKE IT SOMEDAY. Sounds like you just did.

I hope your surgery goes well tomorrow, Chani.

Anonymous said...

Hope your surgery goes well. I did the same thing to a young woman who was trying to "help" me with my phone bill. I called back a week later and apologized and asked a different young woman to please let the original young woman know of my apology. Hopefully it made it through their system.

Take care of yourself.

Laurie said...

I have been there myself, Chani and I understand your frustration. Spending that much time on the phone trying to resolve a problem would drive anyone to that point.

Good luck tomorrow (today, I guess). You are in my thoughts.

QT said...

Chani - I am so sorry for you! You really gave it some effort, tho - 5.5 hours???

Good luck with your surgery today and keep us posted.

Penny. said...

I've said it before.. I'll say it again..

Move to Canada.

Hilarious, Chani ~ Loved these:

Get on the bus to Call Center Hell.

After 5.5 hours on the phone, she could have told me she had a hotline to Jesus Christ and I would have believed her.


Glad you could get the drops. Hope you are feeling better!

Mary said...


I understand your frustration, and heck, I would have dropped the f-bomb under my breath, at least! I just wrote something about customer service not too long ago and I'll share it with you. You might get a chuckle out of it:

I'm glad you have your eye drops...

MsLittlePea said...

Ok I came earlier because I knew you were having your surgery today and then was glued to the news because of the shooting and came back to read this post....

I'll just say this. When I was in Canada, I caught a really bad flu and eye infection. I didn't have insurance at the time and I'm not a citizen but my visit to the doctor cost $15.00 and my medicine(s) cost $15.00. I waited 5 minutes in the waiting room and no one made me fill out any forms saying I wouldn't sue for malpractice or look at me funny when I said I wasn't insured. I caught the very same eye infection 6 months after returning to Florida(both were caught from swimming in a pool) and with my insurance, my visit to the doctor cost $120.00 and my medicine-THE EXACT SAME MEDICINE I BOUGHT IN CANADA FOR $15.00- cost $85.00.

Thankfully, I have better insurance now and sadly, I know not everyone is as lucky as I am.

There HAS to be a better system(sorry if I made you cringe with that word!) than the the lack thereof that we have....I've heard Canadians complain about theirs but say at least they have one and most wouldn't trade places with ours.

I do hope you're feeling better.