A few weeks ago, I spent hours on the phone with people at a medical supply company and Gracie’s insurance company trying to get one of her expensive wound care supplies covered. This particular product is pretty cool. It is a felt-like material infused with silver. When it’s dry, it is soft and easily pulled apart like felt. When it’s wet, though, it turns into gel. It is ideal for infected wounds, because it soaks up the goo that seeps from the wounds and simultaneously infuses the wounds with silver, which is anti-microbial.
At first, I tried to order it the way we order all of Grace’s other wound care supplies—by emailing her doctor and telling her what we needed. A few days later, her nurse called me. The medical supply company refused to fill the order, something about not being compatible with Grace’s insurance. The nurse asked if I would call the supply company. So, I did. The medical supply company folks said that they were not allowed to fill the order for this particular product when Anthem is the insurer. That person recommended that I call Anthem and try to get it approved. So, I did. The customer service rep who first answered the phone eventually transferred me to a supervisor. I explained the situation to the supervisor—that the supplier wouldn’t fill the order because of a block in their system with Anthem, and this particular product is unique, and it helps keep Grace out of the hospital when she has severe wounds. The supervisor was very sympathetic; I got the impression that she would have given me the product right there if she could have. She said that she was a mother, too, and even though her three kids were healthy she couldn’t imagine having to deal with all this. (She was one of the people who called me a good mom.) She, unfortunately, did not have the power to resolve the problem, so she transferred me to the appeals and grievances department.
A couple days later, the person from appeals and grievances called me back. She asked some questions about the product, and how often we go through it (our last box lasted three years, so not too often), and said she would approve the product. I told her that the real problem was that the medical supplier wouldn’t place the order, so she called that company.
A few days after that, the nurse from Grace’s doctor’s office called me back. She had just gotten a message that the medical supply company deleted the order since it had been inactive for so long. Again, she asked me to call the medical supplier to try to get it worked out. So, I did.
I was frustrated when I made that call. I asked for a supervisor immediately, but the initial customer service rep wouldn’t transfer me without knowing what the issue was. When I started describing it, she knew exactly which patient I was calling about. She was defensive, as was her supervisor. The supervisor said that because there is a block in their system for all things Anthem, they could not order the product. She said it’s probably because Anthem won’t pay them much for the product, so it’s a contractual issue. I told her that the victim of her company’s rigidity was a five-year-old child. The person who is being harmed by the company’s refusal to fill the order is a sweet girl, a little child who can’t help that she was born with a disability. She didn’t really care… there was nothing she could do to change the system. At that point, I asked to speak to the company director of consumer relations. She transferred me to the corporate office.
The CSR at corporate was nice, at least. She listened to my story and told me she would transfer me to a certain person who was the company’s equivalent of a director of consumer relations. I left a voicemail for that person, short and succinct but again remarking that the person suffering because of the company’s policy was a five-year-old child. She called me back later that day.
The person in the corporate office was kind and understanding. She offered to send me a box of the wound care supplies for free, but I told her that it still didn’t solve the problem—their company’s policy was still in place. She said she had spoken to the appeals and grievances person at Anthem, and that person informed her that if I paid for the supplies out of pocket Anthem would reimburse me. She said that because of the way their warehouses were set up, they couldn’t ship certain supplies to certain locations. They were not legally allowed to send this particular supply to patients in Colorado because of industry regulations. That made no sense to me, since she was willing to send me a box for free. But whatever.
I go back and forth on whether I should have allowed her to send me the free box of supplies. On the one hand, the company probably has a budget for that sort of thing. On the other, it is the insurer’s responsibility to fulfill my daughter’s medical needs. Ultimately, I set up an online account and purchased the supplies, paying out-of-pocket with only a momentary worry about whether we had enough room on our credit card.
I still haven’t sent in the invoice for reimbursement. That involves yet another phone call to Anthem, and waiting for a response, and hoping it’s an appropriate response. I already feel defeated by the whole experience. I’m glad this is a once-every-three-years purchase; I’m not sure I could handle dealing with this more often.
So what’s the punchline, you ask? Well, the product finally came. I opened the box, took out one of the sheets of dressing, and opened it. It’s the wrong thing—I needed the sheets without thread, and these are the sheets with thread. ARGH!!! I probably can’t send the box back since I opened it. I definitely can’t afford another box of expensive wound dressings. And I’m so, so sick of dealing with these people.
I may call the nice person in the corporate office. I will almost certainly send in the invoice to Anthem. And I will be VERY glad that we only have to deal with this every few years.