This further convinced us that people who claim government-run health care would be more inefficient and mistake-prone than the current mostly private system never have had much to do with an insurance company.
There is no way, absolutely no way, that any public organization could be more difficult, irritating, and time-consuming to deal with than Regence Blue Cross of Oregon is. And here's the scary thing: Regence likely is better than truly malevolent for-profit corporate insurance giants.
On the positive side, we just whipped Regence's ass. I'll save the gloating for another post, where I'll share the details of how we (well, mostly Laurel, but I helped some) won an appeal of Regence's wrong-headed decision to drop Restasis, a dry eye medication, from its formulary.
We challenged Regence and won, after several levels of appeal that ended up with an outside expert physician agreeing with us that Restasis is medically necessary and Regence had no valid reason for dropping payment for Laurel's prescription.
Yesterday Laurel phoned Regence to find out when her coverage for Restasis would start up again, and if (as we expect) Regence will be paying us back for six-plus months of our paying the total cost for this spendy medication.
Here's the sorry step-by-step tale of how our much-vaunted "best health care in the world" insurance system responds to a simple consumer question:
(1) Laurel calls the phone number of Patty Nelson, a Regence Blue Cross of Oregon employee in the Member Appeals department. Nelson has been corresponding and talking with Laurel about her appeal. Laurel hears a busy signal.
(2) Laurels hangs up and dials Regence Customer Service. She's told that Nelson no longer works for Regence. Laurel asks to talk to someone else in Member Appeals. The Customer Service rep has no idea how to reach the Member Appeals department.
(3) Laurel is transferred to several other people, none of whom know how to contact anyone in Member Appeals, which apparently is in some sort of underground bunker that is a secret even to other Regence staff. She ends up talking with a supervisor in Customer Service, Corey.
(4) Corey puts Laurel on hold for a long time. Eventually Laurel is told that Corey was unable to reach Member Appeals. So Laurel is transferred to Pharmacy Services.
(5) Someone in Pharmacy Services tells Laurel that she should talk with Kathleen McNulte, a manager who deals with appeals. When the number she's transferred to rings, the answering message doesn't mention McNulte, saying just "Medical Affairs" -- which is only for providers. The message says that messages can't be left at this phone number, because it is no longer in service.
(6) Laurel decides to press the option for providers, something about medical services triage. This gets her disconnected. Dialing the number again, she reaches Customer Service -- which is where she freaking started 40 frustrating minutes previously.
(7) A while later, Laurel tried again. Again she was transferred by Customer Services to Pharmacy Services, where she spoke with a supervisor. This time she was put on hold for about an hour, while she put the phone on speaker, fixed and ate lunch, and did other stuff.
(8) The Pharmacy Services supervisor refused to give Laurel her phone number. No one at Regence offered to search for the information she needed and call her back. Each person insisted that she stay on the line. Finally Jan from Pharmacy Services came back and said that the person she needed to talk to wasn't in today, so she will call Laurel tomorrow morning.
(9) The next day, Jan did indeed phone Laurel. She said that Regence is trying to figure out what Laurel's winning of the appeal means. The information is being "loaded into the system" (even though the overturning of Regence's denial of Restasis coverage occurred several weeks ago). Laurel was told that no name, phone number, or address of anyone at Regence who is working on her case could be given to her.
Supposedly Laurel will get a letter about all this...eventually.
On the other hand, public employees at the state Insurance Commission have been most helpful, available, and competent. Laurel was told by one of them that Regence has had big layoffs lately, and is working with a "skeleton staff."
Funny, our insurance premium hasn't gone down. I wonder where the money from all the cost savings is going. Probably into CEO salaries.