United Health Care and Oxford Health Plans...

... should be ashamed of themselves.

After much "hondling" with United Health Care/Oxford Health Plans they finally decided to suck it up and do what they should have long ago done and pay for Eliza's formula since it is her sole source of nutrition (as an aside this would NEVER had been an issue if the formula was consumed via a tube instead of orally).

On February 4, 2009 UHC/OXHP precertified both Eliza's formula and calorie supplement. WooHoo, such a nice birthday present for me. So I do what I am told to do by UHC/OXHP and call Medco, their pharmacy provider, to arrange for delivery. After 10 (TEN) hours of calls where I am alternatively told that Medco will direct ship the products and then that they won't ship the products, it is finally determined I need to find a retail pharmacy in my area to "fill" the precertified prescriptions. I am given a list of 26 pharmacies to call, and call I do. Not one of the 26 carries these products since, as one neighborhood pharmacist told me, "there is no profit in carrying products that have such a low demand." These are not standard shelf items.

I call the good folks at Nestle to see if they know of a pharmacy that carries these two products. Nestle claims they have no such list. I find this a bit hard to believe and suspect they much prefer me to continue to buy the stuff straight from them at a hefty profit. Nestle also advises they will not bill UHC/OXHP or Medco directly.

So I sally-forth to the online pharmacies and EUREKA! CVS.com is more than happy to fill the prescriptions! Life is grand, I make room in my small apartment for the cases of nectar that I am anticipating will arrive any day.

Then I get the email from CVS.com stating (are you ready) that UHC/OXHP/Medco have denied the claim since although they are precertified these products are not covered under my pharmacy benefit. Huh? If it is not covered under my "pharmacy" benefit, then one would wonder why Medco was involved at all, since Medco ONLY deals with "pharmacy" benefits and it was Medco that gave me the names of the 26 pharmacies to call.

So I once again dial the UHC/OXHP/Medco 800 number. By now I have spent in excess of 35 (THIRTY-FIVE) hours trying to get the products that UHC/OXHP has precertified. Four hours and three calls later I am told that these products are covered as a "medical" benefit and I need to go to a medical supply company. While I am clearly vexed at the waste of time, I am thrilled to place that call to Apria for the products. I am in luck! Apria carries them and they can be at my door in a jiffy!

Guess what happens next?

UHC/OXHP DENIES the claim from Apria. Why you ask? Because the products are NOT covered as medical benefits but rather are pharmacy benefits. Huh? No dear readers you are not confused nor is your reading comprehension failing you.

So to sum up:

February 4, 2009: the products are pharmacy benefits

February 10,2009: the products are medical benefits

February 23, 2009: the products are pharmacy benefits.

As of today "Jim" a supervisor was "looking into this" since he "felt" this was a pharmacy benefit. Since "Jim" managed to disconnect me after 97 minutes on hold today I am not hopeful that "Jim" has any idea what he is doing any more so than "Tammy," "Sharon," "Lucille," "Jennifer," "Arlene," "Suzanne, "Ronald" or "May" knew in my earlier calls.

I have now spent a full work week trying to simply obtain the products which United Health Care/Oxford has already approved. This is in addition to about 100 hours of my time trying to get the stuff covered in the first place.

This is just wrong and is a simple example of what is so very broken with our health care system. Caring for a special needs child and working full time is hard enough, do these people take some perverse joy in making this even more difficult? I think they do. I am sure UHC/OXHP dearly wishes Eliza was not one of their insureds. Surely they could have used the $2.7 million they have already spent on Eliza for a few swanky corporate outings.

To spite UHC/OXHP I will NOT move our company's group policy to another carrier but rather will make sure that every dime is sucked out of this wretched company. I will happily use my insomnia to their detriment and make their corporate "life" as miserable as I possibly can. Yes indeed.