Eliza Grace was born on March 15, 2006, at 26 weeks, 4 days, weighing 1 pound 4 ounces and measuring just 11.5 inches long. She is the light of my soul and this is the story of our life in the big city.

Monday, September 7, 2009

Now I Know Why Oxford UnitedHealth Group and Medco Have Once Again Failed to Pay Eliza's Claims

... They are simply too busy doling out their hard earned money (a/k/a my premiums) on lobbying against healthcare reform:

Yes, yes I too am sick of repeating my mantra, but once again: no one who has lived a life of good health with their biggest uncovered medical bill being a botox injection or a pack of birth control pills should ever be permitted to run a healthcare company or hold a government position that effects healthcare.

What has brought on my latest rant: In August Oxford UnitedHealth sent us a monthly invoice that was about $9,000 more than the company's regular bill. The number bore no relation to anything: it wasn't twice as much, one and a half times as much, not an extra person or two. Odd. So I call Oxford and after TWO HOURS they decide that they had no rational reason for this "adjustment" to our bill. So I paid what they told me to (our normal premium) and documented this with multiple letters and emails.

Fast forward to this Friday morning. I get a call from CVS.com advising that although Eliza's doctor's office had finally sent in the information for preauthorization of her formula, that our policy had been cancelled as of August 31, 2009 for non-payment of premium. Hmmm. We paid the premium, check was cashed and all. Apparently some nitwit at Oxford UnitedHealth Group had simply seen that I had paid less than what his computer showed and without batting an eye cancelled our group policy. Sweet. So after another TWO HOURS on the phone with Oxford UnitedHealth Group, they decided that yes, in fact our policy had been timely and fully paid and they conceded that it is ILLEGAL in New York to cancel a policy for non-payment of premium without notice. So they nicely reinstated our health coverage back to August 31.

While I am sure they were waiting for me to whimper with joy at their benevolence, they mentioned that it would however take up to 96 hours for Medco to get around to reinstating coverage. Not what I wanted to hear since I had a pending pharmacy order of about $700. No real reason was offered as to this delay in our pharmacy benefit being reinstated, other than "these things take time." They suggested that if Eliza really needed the pending order, that I pay out of pocket, submit a claim and they would reimburse me in 3 to 6 months.

And there are people out there who don't think we need healthcare reform?


Anonymous said...

I was just cruising these blogs and stumbled on yours. I am a pharmacist, actually I have my own store and I can tell you that medco and all the other pbm's are pure evil. They run this country. They dictate policy in government etc and are concerned with only one thing, your money and how to hold on to it. All of this makes me think of that remark Palin made about death panels. Listen, insurance has been running death panels forever, and probably Palin has taken contributions from these same companies. No question, we need reform.

Anne, Eliza Grace's mom said...


I have now taken to rolling my eyes, perhaps too dramatically, everytime I hear someone talk about not wanting the government or a third party to make health care decisions for them. Well right now employers (like me) are making health care decisions everytime I renew our policy and change (or usually limit) the benefits because of the rising costs, or self-insured employers who are essentially deciding what claims to pay or not to pay.

Medco/ Oxford UnitedHealth actually argued with me for the past two years, each and every month about my daughter's Synagis injections. They very reluctantly paid the thousands of dollars per month for the shots, but not the $2.40 for the syringe. I refused to pay the $2.40 per injection just on principle since they could never answer how they expected the Synagis to get into Eliza unless she was annointed with it like a holy oil, which was proabbly contra indicated on the prescription insert.

Medco and Oxford UnitedHealth have mastered the art of healthcare tennis. For over a year Oxford insisted Eliza's formula was a pharmacy benefit and Medco would refuse to process the claim insisting it was a medical benefit. Of course during this entire time neither one could care less if Eliza starved or if I went broke paying for the formula.

They are evil. Pure evil. Until someone has to deal with them on a daily basis and the worse thing they have done is switch someone's Lipitor for Zocor, they have no idea how evil the Medco's of this world can be.

... and don't get me going about the lovely Ms.Palin! :)