I wanna let you in on a secret, insurance companies are out to make money on you. And if you find yourself in a position where the insurance company can not make money on you, they will figure out a way to get rid of you.
Went over to my mom's house today(cause our house smells of glue) she was on the phone with her prescription drug company(Express Scripts). She has one of those companies that you pay $20 a month and mail your prescription to them and they send you a month or 3 month supply. Well mom has tons of pain and is on ACTIQ a fairly expensive narcotic lollipop. She sucks on 3 of them every few hours 24/7/365. She goes through hundreds of them a month. They arrive at her house (when they arrive) in 54 cases of 30 lollipops each, this shipment costs my mom's drug company $9,000 she pays $20.
Obviously this is a huge loss for Express Scripts(not recommending them). I am sure the company doesn't pay full retail of $9,000 for the lollipops but I bet they still loose a good bit of money. So how does the company deal with there loss & my mom's prescriptions.
They are out to screw her over. There is not a single order that has gone through the express scripts system that they haven't messed with her. They have slowed her order down, lost her order, forgot to pre-authorize her, made her take one prescription and break it into two prescriptions, lost one of the two prescriptions. Every time they mess up they require my mother to go back to her doctor make him write a new prescription and mail it in, they then do not expedite her order, they start over from the beginning every time. They have managed to slow down her delivery, have made her run out of medication for weeks before refilling, leaving my mother in pain.
I have two guesses as to why this is happening: 1) Express Scripts is incompetent, in which case they should not be in charge of filling prescriptions. 2) Express Scripts is out to stall my mother from getting her medication on time. For every day they can prolong my mother from getting her meds they save money. It is much cheaper to pay a telephone operator $6 an hour to listen to my mother complain than fill her $9,000 order.
I am recommending my mother, who has been documenting all this in a journal to get a lawyer. I figure the only way she can get any satisfaction out of Express Scripts is to take them to court for false representation. This way the insurance company will have to weigh the cost of a lawsuit vs. filling my mother's prescription, this may or may not motivate them more. I wish it wouldn't come down to this, but i wonder what our other choices are.
Others complaining online about Express Scripts : Consumer Affairs