Forty-five minutes after first dialing the number on the back of my insurance card, I’m still on hold with Blue Cross Blue Shield Anthem as I write this blog post. My cell phone burps out obnoxious elevator music on speaker beside me on the desk as I type. But I’m getting ahead of myself. Let’s start from the beginning: Africa.
Not in Africa, exactly, but in a manner of speaking. In the middle of June, I’ll be leaving Boston to spend the next two months in Rwanda, where I’ll be participating in a social entrepreneurship project in rural Rwanda.
Still on hold. Now the count’s at fifty minutes.
Traveling to Rwanda means, among many other (and better) things, vaccinations and medications. I’ve already gone to the travel clinic for five shots: Yellow Fever, Typhoid, Influenza, Polia, and Tuberculosis. Unfortunately, Malaria continues to be a threat in Rwanda. I’ve opted for Doxycycline because some of the other pills have psychotropic side effects and I don’t really dig crazy dreams. The RN at the travel clinic wrote me a prescription for 87 pills and sent it to the pharmacy. Enough pills for each day in Rwanda plus time before and after.
I’ve been disconnected once already from the insurance company; this is the second call I’ve placed. Both times, I was greeted by the automatic voice generator that kept stating, “I don’t understand what you said,” when I tried to recite my insurance policy number out loud for “more personalized care.” “For more personalized care, I’d actually like to speak to a human being,” I mutter. “I don’t understand what you said,” comes the automated response.
Seventy-one minutes later, the BCBS representative with whom I’ve been speaking for the past hour (let’s call him Paul) checks in again to thank me for my patience. He’s already tried calling three different internal numbers (one of which he was disconnected from and another of which rang unanswered). He’s also phoned my pharmacy to talk to them. “Can I call you back on Monday?” he asks. “No, but thank you,” I respond. “I’ll continue holding, as I’ve done for the past hour. I’d like to get this situation resolved by the end of the day.” I’m practically an expert now at holding (let me know if you need any tips!). He tells me that my case will be transferred to a senior representative, but they’ll need to do a bit more research before above-mentioned unknown person can get back to me. “Do you mind if she calls you back in an hour?” he asks me. I sigh. Of course I mind, but what can I do? “No, that’s fine,” I whisper into the phone, feeling my case slipping out of my hands as it drifts into the murky blue abyss of BCBS.
I still haven’t told you what the problem is and why I picked up the phone in the first place, so while I’m holding, I’ll fill you in. In addition to needing a two-month supply of Doxycycline to avoid getting Malaria, I also need a three-month supply of birth control. Ah, yes. Therein lies the problem! Needing a three-month supply of birth control is obviously suspicious. I must be up to some really crazy things.
This morning, before this ridiculous phone call, I opened the crinkly white paper bag from the pharmacy only to find a very small orange bottle filled with thirty capsules of Doxycycline. “Um,” I said to my mother, “where’s the rest of it?” “Here,” she said, handing me one package of Mononessa. “I mean, where are the other pills and the other two packages of the Mononessa?” I asked. She shrugged. “They wouldn’t give it to me.”
The insurance company won’t authorize more than a thirty-day supply of any medication.
I’m not sure if the insurance company understands how antimalarial or birth control pills work, but in case they’re unaware, I’ll gladly share! Doxycycline is a daily antimalarial pill, which means it actually needs to be taken every day in order for the medicine to work effectively. Birth control works the same way. One pill every day. As tempting as it is to play Rwandan roulette and ration out my thirty Doxy pills over eight weeks, I think I’ll get my kicks another way.
Hence, the phone call to my insurance company.
After the robot lady got done talking about how awesome BCBS is and about how she didn’t understand what I was saying, I pressed zero for the operator. I spoke with someone about my problem. She put me on hold for ten minutes. “I’m sorry,” she said when the elevator music shut off. “I don’t have access to do anything. Let me transfer you.” Sure, no problem. The waiting game began.
Ten minutes later, I was on the phone with Paul, and I explained my problem again: “The travel clinic prescribed me a two-month supply of Doxy and the gynecologist prescribed me a three-month supply of birth control. The pharmacy will only give me one month of each. I’m travelling to Rwanda in two weeks and I’m not going to have access to a pharmacy. Can you please authorize a vacation override for these prescriptions so I can travel with the medication that I need?”
This is when Paul put me on hold and started making all of those other calls that I already mentioned above. In between the second and the third call, he picked up the line. “Kayla, are you still there?”
“I’m getting the run-around from everyone around here, and I can’t seem to find any answers. I’m going to try a third number. From what I understand of the policy, though, you’re allowed to have two vacation overrides within a period of one hundred eighty days, but they must be thirty days apart.”
“Sorry?” I asked. From what I understand of the policy, you can’t go on an extended vacation and have two medications at the same time. From what I understand about the policy, I’m being asked to choose: antimalarial pills or birth control.
“I know,” Paul said. “I’m just as frustrated about this now as you are.” I want to believe Paul. I want to believe when he says that he empathizes with my problem that he really does understand the panic I feel about being away from home for two months without access to the medication I need. But I doubt that Paul has ever had to choose between antimalarial pills and birth control. “What’s the number for your pharmacy?” he asked, and I gave it to him. He put me on hold again.
“Okay,” he says when his voice crackled back to life on my phone. “The pharmacy can’t do anything about it today. Their system won’t allow it since there has already been action today on those prescriptions. And they can’t actually find the scrip for the Mononessa.” Now we’re all caught up to minute seventy-one when Paul offers to do some research and call me back on Monday. I politely decline and ask to speak to a supervisor. I’ve already invested an hour and a half on this problem today, and if today is any indication of how long this process is going to be dragged out, I don’t have time to wait until Monday to figure out if the pharmacy can actually fill my prescriptions.
I get bounced around to three more people before I get a supervisor, who informs me that she’s spoken to the pharmacy and the prescription company and that I’ll be able to pick up both prescriptions tomorrow. Huzzah! She tells me that in the future I’ll need to order my three-month prescriptions online because there are no restrictions or need for vacation overrides online. “What’s the difference between buying at the pharmacy and buying online?” I ask, wondering why I had to go through the disaster this afternoon just to pick up my prescriptions at the pharmacy.
“It’s cheaper for the insurance company,” she responds, “because they don’t have to send the medicine to the pharmacy. In truth, I’m not sure why you even called this number or how you ended up speaking with us.”
“I called the member number on the back of my insurance card,” I stutter.
“Yes, well, we only deal with the medical side of things. Most people don’t realize that we’re a different company than the drug providers, even though you pay the one premium. You should have called them directly. Instead, we did that for you,” she hisses.
“Why didn’t the very first woman I talked to tell me to hang up and call the drug company directly?”
“Well, I don’t know. But you shouldn’t have called us.”
Thus ends my phone call with the friendly folks at BCBS, but as I have yet to pick up my prescriptions because I’m not allowed to today, who knows what fun adventures await me tomorrow?
My point, after all of this, is actually two sub-points: first, it is clear that the insurance system in this country is deeply flawed. While it is true that I know very little about economics, I do know that it might be a good idea for health insurance companies to prioritize the needs of their clients over their own interests (they’re going to make money no matter what). The RN didn’t prescribe me 87 Doxycycline pills because she thought, “Hey, 87 is a fun number! Let’s go with that!” She prescribed 87 pills because that’s what I needed, and the insurance company gave me 30 pills because that’s what the insurance company wanted.
I’m not afraid to stay on hold for three hours and to demand to speak to someone who actually has the ability to solve my problem. But there are people who are afraid or who can’t fight with these people, and this is my second point. What about people who have more complex medical problems who only get bounced around? What about the people who file claim upon claim only to discover that they’ve all “never been received”? What about fifteen-year-old girls who are looking to be put on birth control but have no idea how to navigate this web of insurance benefits? What about the people who hang up after only one person tells them “no”?
This is a feminist issue because it is an everyperson issue. Why are we making it difficult for people to gain access preventative medications? Why are we saying to young women, “Hey, that’s cool if you want to travel and try to make a difference, but you’ll have to jump through ten hoops to get enough birth control to take with you on your trip, if we even decide to give it to you at all”? The process is ludicrous.
My suggestion to BCBS and the rest of the insurance companies out there is this: for “more personalized care,” try caring about the person on the other end of the line.