I'll have a Blue (crossed) Christmas…

I just got a phone call from my pharmacy. It turns out that a prescription I had dropped off needs written permission from the doctor before the insurance company will authorize payment.

Stupid me. I thought that’s what a prescription WAS — the doctor saying in writing that she wants me to take this particular drug — but apparently, to Blue Cross of California, that isn’t sufficient. Naturally, neither my doctor nor BC’s customer service office are available on weekends, so I get to wait until Monday to deal with this particular issue. But I’m already imagining on just what might happen.

Update: Apparently there is some confusion about my situation. First, the prescription is NOT THAT TIME-SENSITIVE — waiting to start a couple days won’t kill me, or even cause me more than a smidgen of annoyance. If it was, I’d get on the doctor’s answering service immediately. Second, everything below this is strictly fictional and satirical — every word is false, including “and” and “the.” I greatly appreciate the concerns, folks, but please, don’t waste it on me — save it for someone who NEEDS it. And thirdly, Hunter, the problem isn’t the pharmacy. They’d gladly give me my meds right now if I paid full price. The real swine here is the insurance company.

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“Blue Cross, how may I help you?”

“I have been told that to get a certain prescription filled, I need written permission from my doctor. I thought that was what a prescription slip was.”

“No, sir, that is not sufficient. We need the doctor to fill out a AOPS-17 form before we will authorize payment.”

“AOPS-17? What’s that?”

“Affidavit Of Pinky Swear. It’s the doctor saying that she really, really wants you to take the medication.”

“OK… but is that absolutely necessary?”

“If the doctor is unavailable, then you can fill out and fax in a form CMH2TD to us directly. That’s a ‘Cross My Heart, Hope To Die’ declaration that the doctor really did tell you to take the medicaiton.”

“Can you fax me a copy?”

So I fill out the CMH2TD and fax it back, then head off to the pharmacy. There I find out it’s still being denied. I call back.

“My prescription is still not being covered, even though I sent in a signed CMH2TD form.”

“Did you also sign the SNIME Codicil? Because we cannot process CMH2TDs without the SNIME Codicil attached.”

“No, I wasn’t sent anything about SNIME. What is that, anyway?”

“That’s the Stick a Needle In My Eye clause. CMH2TD forms are invalid without them.”

(sigh) “Can you fax me one of those as well?”

So I sent it off, and went back to the pharmacy. Denied again.

“Blue Cross? I sent in the SNIME, but I was still denied.”

“Did you send it by itself?”

“Yes.”

“I’m sorry. Our policy is to discard any SNIMEs that come in without an attached CMH2TD.”

“Can’t you just find my original CMH2TD and put them together?”

“No, those are discarded, as well.”

Luckily, I still had my originals of both, so I sent them in together. Then I trekked back to the pharmacy, where they finally filled my prescription.

One week later, I get a letter in the mail from Blue Cross. It’s a Form SDS-12, denying my previous prescription coverage. Also in the mail is a bill from the pharmacy. I call Blue Cross again.

“Blue Cross, how may I help you?”

“Yes, I just received a Form SDS-12 in the mail, along with a bill for a prescription I had filled a week ago.”

“Yes, sir. That’s the ‘Simon Didn’t Say’ form. We have determined that your prescription should not have been covered.”

“Couldn’t you have decided that BEFORE I picked it up?”

“Tell you what, sir. I can file a OTDO-18 — that’s a ‘One-Time Do-Over’ — and we’ll cover it this time. But in the future, you will need to submit a SS-23 three days in advance or your prescription will NOT be covered.”

“SS-23. That would be the ‘Simon Says’ form?”

“That is correct, sir.”

So I finally get all the paperwork done and happily take my medication. But three weeks later I go for a renewal and again I am refused. I call them back.

“Blue Cross, how may I screw you?”

“I beg your pardon?”

“Blue Cross, how may I help you?”

“I just went for a renewal on my prescription, and it was denied.”

“Let me check on that… oh, I see the problem, sir. You shouldn’t be out of the pills yet.”

“Huh? I got a month’s supply, and it’s been four weeks. They’re all gone!”

“But our files indicate no MMI requests from you. Without those requests, you should not be actually taking those pills.”

“MMI requests? What are those? I’ve never heard of that.”

“Those are the ‘Mother May I’ requests. You need to make them to us before you actually take any medications covered by your prescription plan.”

At that point I made an appointment with Dr. Kevorkian. If ANYBODY takes Blue Cross of California, it’s gotta be him. And after my appointment, I’ll let BC-CA fight with my estate. I won’t care any more.

J.

Count Every Vote
Nos Morituri, Salutamus!

23 Comments

  1. pylorns December 4, 2004
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