|Insurnace Quagmire HELP!
Aug 3, 2004
In 2002, I used Statscript Pharmacy, a division of Chronimed, as my pharmacy. I was insured by United Airlines, a self-insured company that used Blue Cross Blue Shield as their administrator. I was covered under my domestic partners insurance. In April 2002 I was prescribed Serostim, an HIV/AIDS related medication. Serostim is quite costly and requires pre-authorization. When I dropped the prescription off I asked the staff pharmacist to get the authorization before filling the prescription. About a week later the pharmacy called to inform me the medication was ready. When I asked if the authorization had been taken care of I was told yes.
I continued to have prescriptions filled there for another nine months. Each month I asked if there were any issues on my account and was consistently told everything was in order. Then, in November of 2002, I was told my business was no longer welcome at Statscript because I had too many unpaid and rejected claims. This was the first I had heard of this. I was also in an in-patient facility at the time, so hardly had the resources to investigate. In January of 2003, I called the pharmacy to arrange a meeting to go over the claims. The pharmacist said she would mail me a detailed accounting of the unpaid claims. This never happened.
Seven months passed and in August 2003 I received a call from the pharmacy asking if I would cooperate with their corporate office in getting these claims paid. Of course I agreed. I began corresponding with a Cory Veeck of Statscript. He informed me that BCBS had halted ALL claims payments (of all medications) after the first dispensing of Serostim. He copied me a letter from BCBS to my doctor demanding ten years of complete medical history, without my authorization. They told Mr. Veeck that they would not even consider my claims until this information had been received. Of course my doctor would not send the information based on two grounds 1) they did not have my consent and 2) it was not pertinent and specific to the prescriptions in question. When I called BCBS to get the information needed to release to my doctor, BCBS would not even talk to me, saying that they did not need my authorization and it was none of my business.
Finally, in October of 2003, I was able to determine on my own what medical records to have my doctor release. The records were sent and BCBS claimed to never receive them. It took another five months and three copies sent to them that they acknowledged receipt of the medical information. During this time, when I corresponded with Mr. Veeck we discussed strategies we could employ to get BCBS to pay the claims. Mr. Veeck specifically told me that as long as I worked with them, they would not pursue me legally. He also specifically told me not to engage in any of these alternative strategies until final disposition of the claims had been made. I checked with Mr. Veeck about once per month to find out the status and he simply said BCBS had not made any determination.
Then, on June 19, 2004, Mr. Veeck informed me that BCBS had still not made any determination of the claims and that due to fiscal year priorities, Statscript would be sending me, the patient, into collections for an amount somewhere over $100,000 to be collected immediately.
I am a part time flight attendant and have HIV/AIDS disease. That amount is about three times what I make in a year. My only option I can think of is personal bankruptcy, which only lets the true guilty party, BCBS and United Airlines, off the hook. It gets Statscript nothing while it devastates my life.
I tried to contact VIPs at Statscript and they would not return my calls. So I wrote a statement (see attached) and faxed to about 25 of their pharmacies in hopes I would gain their attention. I also faxed it to several non-profit agencies with a plea for help.
I was properly and legally insured by UAL/BCBS; even if they were to reject the Sersotim they are bound to pay all other claims, but they have refused to process any of these claims.
Obviously I need some help. I keep getting the advice that I need an atorney. Well, duh. But I do not have the financial resources to obtain one, if one would even be willing to help me. I have inquired with several attorneys and each has told me there would be nothing in it for them to take this case. Additionally I have contacted AIDS legal support services in New York, Chicago, San Francisco, LA and Detroit (each one repeatedly). I have received next to no response and when I have, it has been to tell me they could not help. This is quite discouraging.
It is disgusting to me that UAL and BCBS will get off scott free while I have to declare bankruptcy. I did nothing wrong, I simply followed doctor's instructions to stay alive.
| Response from Ms. Breuer
Please do not declare bankruptcy. Immediately contact your state's insurance commissioner, explaining your situation clearly and cogently, as you have here. Phone first to determine the correct contact information, let them know your letter is coming, (preferably via fax) and ask how you can best follow up. This is just unconscionable. I recommend that you copy the letter to the insurance commissioner to the people you have been working with at Statscript,BCBS and United. In your first paragraph, explain to the commissioner that you have done all you know how to do to resolve this problem and need his/her office's help, since at no point have you acted in anything but good faith.
By the way, attachments do not come through on this forum email system, so there was no attachment for your document.
I recommend that you also contact your congressperson and state senator to ask for their help. They have office staff members who work on these kinds of issues for constituents all the time. The better your documentation is, the clearer and more "sane" you sound, the more likely you will be to get help. The last thing you need is bankruptcy.
Make sure your letter is chronological, preferably with bullet points, stating at each step of the way (just as you have here) what happened, why it happened and what you did to resolve it.
Please let us know how this contact turns out. You are caught in the gears of a failing health care system. Please remember that as you decide how to vote in local and national elections. This is a key issue for people with HIV.
My best to you.
Get Email Notifications When This Forum Updates or Subscribe With RSS
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.