UPDATE, on 23 January 2013: The die is cast. Contacted with full details, I've asked for investigation from my state's Secretary of State, who oversees the Board of Pharmacy as well as the entity in charge of pharmacy licensure, from the US Department of Health & Human Services (HHS), Office of Inspector General (OIG), Office of Investigations (OI), OIG Hotline Operations, and I updated MEDCO/ExpressScripts on all of these shenanigans. MEDCO/ExpressScripts provided me with a particularly illuminating bit of information. While Walmart Pharmacy charged $170 for this poor beleaguered prescription, and that for a thirty day supply, MEDCO/ExpressScripts would have required a $150 charge for a NINETY DAY supply. Yowza! There is more of my cash stuffed in some ne'er-do-well's wallet than I thought. It is a bona fide pain in the booty to do all of this, but I am so grateful to President Obama's ACA provision, the creation of PCIP, which has helped me to help myself, that I can't let this con go on... Besides, I want my money back.
UPDATE, on 1 February 2013: Well, two of three investigations are afoot! And in the interim, Walmart has continued its idiocy. They notified be my email late one evening, around 11 pm, that my "prescription is ready!" but dated it November 2012 and that if it were not picked up my November somethingsomething 2012, it would be "canceled." Clever idiots! But best of all... actually, scariest of all, they REWROTE the prescription, but kept my doctor's name on it. Uh-oh. That's *beyond* DUH. On the positive side of things, my properly filled 90-day supply of the medication is scheduled to arrive on Monday from Express Scripts.
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First, I want my Dear Readership to know that I am not writing in anger, nor even in frustration. I sort of expected to have to take this matter "public," and so have been surprisingly circumspect over the last few weeks of this rather bland drama.
But it concerns health care fraud, and that's something I've become much too familiar with, and something I have decided I won't abide and that I will confront, in any way possible.
There is a corporate entity involved -- and remember, "corporations are people, too" -- and that corporation is huge: Walmart.
My particular charge of health care fraud by Walmart is not an all inclusive one. I don't know that it extends beyond the local mega-store pharmacy we've dealt with, but since this is the second instance of it occurring to me, I feel comfortable with the assumption that it is fairly widespread.
Here's the story:
Following my recent hospitalization for g.i. bleeding, I met with my superb MDVIP Go-To-Guy Doctor on January 3, 2013. In reviewing my medications, we noted that I had progressed through the usual drugs that protect the stomach and esophagus, and that they clearly had failed to provide enough protection. That left, of course, ONE drug to try.
This drug would require, he told me, "prior authorization" from the insurance company, as they need to know that the proper order of drugs had been tried, and that they had failed. That made sense and he was ready to provide the necessary documentation.
I am one of the lucky Americans -- blessed, even -- to have benefited from the Affordable Care Act through the creation of the Pre-Existing Condition Insurance Plan (PCIP). After having BCBS gouge me and drive me out of coverage by requiring a premium of $1513 a month on top of a huge deductible and reduced benefits, PCIP was a life-saver, allowing me to continue to be responsible for my insurance payments, but payments not designed to impoverish me (further!). I found PCIP, administerd by GEHA, to be incredibly efficient and well run.
Through PCIP, I had access to the mail-order pharmacy Medco, that has now merged with Express Scripts. I receive all of my "established" and longterm medications through them. When I first start a drug, the routine is to take an initial prescription to a local pharmacy, so that we can make sure the medication works before we establish the longterm prescription via mail-order with Medco.
The local pharmacies -- as you all know -- then run the new prescription through the insurance company and charge the negotiated amount, which is then applied to any outstanding deductible, as well as following any proscriptions such as requirements for "prior approval."
My doctor called in the prescription to the local Walmart pharmacy that we have used for years and expected to be queried for supporting documentation for the prior approval.
Giving it a few days, I began checking the nifty online access to prescription information provided by Walmart -- and each time saw that the prescription was "processing." When a week had passed without word, I called.
The first person I spoke with confidently told me that they were waiting on my doctor's office to supply the prior authorization information. That sounded odd to me, but in the realm of the possible. "Would you like us to fax him again?" I said that sounded like a great idea.
So, of course, I checked with my doctor's office. The stories did not... coalesce. They'd not yet been contacted, at all, by anyone.
By chance, as all this was floating around my head, I was cleaning out my email box, and Miracle of Miracles found an email from the day before, from my local Walmart Pharmacy, saying my prescription was ready to be picked up! They listed a charge of about $170, which made me wince but was not unexpected.
It is the season, after all, of new deductibles. I had a terrible year, health-wise, in 2012, and had hit "catastrophic" coverage of 100% ridiculously early in the year. But 2013 has arrived and it was time to feed the deductible again.
I gave Fred a head's up, requesting that he pick up the mysteriously ready drug, and he headed out -- Fred is ever kind.
He came home angry. The local Walmart pharmacy had not filled the prescription, telling him: "We weren't sure she would want to pay for it." A very strange thing to say, an odd assumption to make, and, were they really so concerned about my desire or ability to pay, they had myriad ways of contacting me to simply ask.
Anyway, after asking him to "shop for a while," they filled it, he paid for it, and came home -- still mad, and also laden with odd puchases he'd made while wandering the aisles! We've enough bird seed for the next few years and the cats have sufficient litter for months, and me, five varieties of apples. Bless Fred.
Okay, so, yes, then I got angry, too. During the extended wait -- he was gone several hours -- I checked online with Medco to learn about this new med, and then to verify what the price should be, and to see when the prior authorization had been resolved. The disconnect between the woman on the phone telling me the rx was NOT filled because of waiting on my doctor to fulfill his obligations, and the email trumpeting that the drug was ready, and had been ready for a full day... well, it just bugged me. I double-checked and the Walmart site still listed the rx as in "processing" mode.
That's a whole bunch of irreconcilable truths.
To which I could now add another: Medco's listed price for an outside pharmacy was very different from the $170 Walmart had pulled out of its hat. And they still marked the drug with an asterisk, reminding me that they would need to prior approve the med.
Walmart had never contacted Medco at all. Nor my doctor. And it appears that they had even failed to talk to one another in concocting a cover story. How do I know that?
I called the local Walmart pharmacy again, and this time spoke with a not-so-deft liar.
First, I thanked him for getting me the drug without obtaining prior approval. How had they managed that, I inquired. Lonnngggggg pause. "Um, we knew that you must really, really need it."
It went downhill from there.
You should know that this is the second time this particular pharmacy failed to run one of my prescriptions through my insurance for proper approval, appropriate pricing, and credit of my payment to my deductible. At that time, I dealt with one ne'er-do-well, and felt like the issue was resolved -- although he claimed to be unable to give me the appropriate refund by crediting the credit card used in the purchase, and actually insisted that we take cash.
I have access to two pharmacies close to Marlinspike Hall, and the other one rarely has the drugs I need, so I had returned to Walmart for these, usually, one-month supplies. They had filled other prescriptions the day after I was released from the hospital in December -- no problems, but again, that was back in the year of 100% coverage.
The icing on the cake during that second phone call? I explained in clear terms my comprehension of this scam, that they'd not gotten away with it last time, and that they would not this time. However, I told the stammering man, this time I was not feeling so forgiving and if they didn't rectify things immediately, "I will come after you."
"Yes, ma'am. Okay."
This nonsense is so tiring.
I then sought ways to contact Walmart corporate entities. Good luck with that, my friends. I emailed what purported to be a corporate contact and received no response.
Were I a corporate entity being accused of health care fraud? I'd not ignore me.
Since then there has been a flurry of Twitter offers to "help," to "listen," and even to "resolve." All from people named John and Betty and Jane and Belinda. No last names, no identification information, just Twitter nonsense.
I was asked four times to resubmit what I had written to "corporate."
I had no intention of blogging about Walmart's fraud -- which must be widespread if it has happened to me twice -- until I got this in my email box. Oh -- you should know that I never allow conflicts such as this to be addressed by telephone contact. I have a weird hangup about getting things in writing.
I also had no intention of contacting the Office of the Inspector General or my local Board of Pharmacy, either, but I am seriously considering it, now.
Why now? Because I finally got a response, of sorts. From a Walmart FACEBOOK page "person" named Shannon. In essence, the Walmart Facebook team couldn't do a darned thing without my phone number. So sorry!
That's okay, I reassured the obviously distraught Shannon. I have a blog.