Main Character, a woman with Lyme, fibromyalgia, allergies, thyroid disease, and a messed-up spine, is trying to get a doctor to authorize her brand-name Neurontin (a painkiller that works on nerve pain). She gets weird rashes and chills from using gabapentin, the generic version of the medicine. She got a threatening letter from her insurance carrier, saying that after April 1 they weren’t going to pay for the brand-name version without a doctor’s authorization.
A small apartment with a ratty loveseat. Colorful pillows are strategically arranged to hide the rattiest parts of the loveseat. Main Character enters stage left in faded black yoga pants and an ancient T-shirt from the Gap, wearing a headset (easier on the neck) and carrying an old cordless landline phone. She sighs, knowing she can no longer procrastinate dealing with the bureaucracy. She dials the number of her primary care physician’s billing person.
Main Character: Hi, may I speak to Yulia?
Receptionist: Please hold.
MC: Hi, I called you last week about getting brand-name Neurontin. My insurance company sent me a letter saying I needed a doctor’s authorization for the brand name. I’m allergic to the generic gabapentin. You said I should call you today to check on it.
Yulia: Yes, I call insurance company. They say Neurontin is not problem with brand name.
MC: No, it said you had to go on the Internet and make a request. OptimaRx.com. O-p-t-i-m-a…
Yulia: Yes, I call. I call two times.
MC: But I got a very specific letter saying that I would not have coverage for brand-name Neurontin as of April 1.
Yulia: Probably letter was mistake.
MC: But it was very detailed, and it says someone from my doctor’s office has to go online and request an authorization.
Yulia: They said was mistake.
MC: OK, I’ll call them. Thanks. (Hangs up.)
Same setting. Main Character is trying to do deep breathing as she calls her prescription drug insurance company.
Computer Voice: Welcome to United Healthcare for Oxford. Are you calling as a member, provider, broker, or benefits administrator? What can I help you with today? Say “claims,” “benefits,” “referrals,” or “help me with something else.”
Computer Voice: Would you be willing to take a brief survey at the end of this call?
Agent: May I have your name, date of birth, and member number?
MC: (Gives info.) I’m calling about brand-name Neurontin? I got a letter saying I need a doctor’s authorization to get it after April 1.
Agent: Neurontin isn’t showing up in the computer, but that’s probably because it’s not April 1 yet.
MC: My doctor’s office said they tried to call, and someone told them I didn’t need authorization. They said the letter I got was a mistake.
Agent: I don’t think it was a mistake. It just won’t show up in our computers until April 1. They need to make the request online.
MC: OK, I’ll tell them.
Main Character is stretching, lying on trigger-point massage balls, and trying to visualize a beautiful, peaceful place. She calls the primary care doctor’s office again, missing Yasmina, the sweet Middle Eastern billing person who retired and left the patients at the mercy of Yulia, the mean new Russian billing person. Main Character, whose grandparents came from Russia, thinks of the few Russian curses she remembers.
MC: Hi, may I speak to Yulia?
Receptionist: She is busy.
MC: I’ll call back.
20 minutes pass.
MC: Hi, may I speak to Yulia?
Receptionist: She is still on the phone.
MC: I’ll wait.
Five minutes pass. Main character reads page from “Why Can’t I Get Better?” by Dr. Richard Horowitz.
MC: Ahem. Still here.
Receptionist: Look, she did her part. She called.
MC: But the insurance company said she was supposed to go online.
Receptionist: Look, I don’t know what you want us to do.
MC: Go online!
Receptionist: Call us after April 1.
Same setting, except now Main Character has thrown some pillows and papers at the wall and is twisting the wire of her phone headset and yanking her hair. Main Character calls her friendly neighborhood pharmacist, Carlos. He is a nice guy, and besides, she gives the pharmacy plenty of business because she fills a LOT of prescriptions.
Carlos: Hello, The Modern Apothecary … Heyyyyy, Main Character!
MC: Hi Carlos! I got this letter saying I needed authorization for brand-name Neurontin after April 1, and my doctor’s secretary won’t go online and request it.
Carlos: OK, why don’t you pick up the prescription from us at the end of March, so you have some to get you through most of April. Is there another doctor you can get the authorization from?
MC: Maybe my osteopath. Do you think they’ll accept an authorization from an osteopath?
Carlos: Sure, why not? They accept prescriptions from osteopaths, right?
MC: Oh, great, Carlos, you’re the best! Thanks so much!
Main Character calls osteopath’s office.
Emily: Hello, Spine and Wellness Associates, Emily speaking.
MC: Hi Emily, I need to get an authorization for brand-name Neurontin because I’m allergic to generic gabapentin.
Emily: Please hold. (Music for one minute).
Anne: Hello, Spine and Wellness Associates, Anne speaking.
MC: Hi Anne, I need to get an authorization for brand-name Neurontin because I’m allergic to generic gabapentin.
Anne: Please hold. (Music for thirty seconds.)
Beth: Hello, Spine and Wellness Associates, Beth speaking.
MC: Hi Beth, I need to get an authorization for brand-name Neurontin because I’m allergic to generic gabapentin.
Beth: Please hold. (Music for ten seconds.)
Dr. Glazer: Hi Main Character, how are you doing?
MC: Hi Dr. Glazer, I got this letter saying I needed an authorization for brand-name Neurontin. My primary care doctor’s billing person won’t go online. Can you help me?
Dr. Glazer: OK, OK, don’t worry, I’ll do it for you. Just send me an email.
Me: Thanks, you’re the best!
Later that night:
Dear Main Character,
Well, it was a big hassle, but I got you approved.
Good luck and have a good night. See you at the next appointment.
One week later. Main Character enters stage right after having returned from acupuncture. She decides to check the status of the Neurontin, just to be on the safe side.
Computer Voice: Welcome to United Healthcare for Oxford….
MC: I’m just checking to see if my medication was approved.
Agent: Oh, I don’t see anything in the computer. Oh wait, it does say here that someone named Yulia called from your doctor’s office.
MC: You should have something from a Dr. Glazer. My other doctor said that he filled out the full request online, and it was approved.
Agent: I’ll have to reach out to OptimaRx.com.
20 minutes of classical music.
Agent: Well, there is no request on file.
MC: But I had my doctor fill out the request in advance. He said it went through. Wasn’t I supposed to do it before April 1? I got this letter in February that said my doctor had to go on the website and request an authorization.
Agent: No, that has to be done AFTER April 1. We just send out a letter telling our members that they won’t have coverage after a certain date.
MC: Wait, but the letter you sent just said people should go online to request authorization for the medicine. It didn’t say anything about not being able to request authorization in advance.
Agent: Well, that’s our policy. We just notify people that there’s no coverage after April 1.
MC: So, people are just supposed to walk into the pharmacy on April 1 and not have any coverage? And then somehow get the authorization the same day?
Agent: Well, yes, they would have to get the authorization that day.
MC: But you can’t just get an authorization that quickly! You have to call the doctors office, the billing person has to be there, sometimes they have to fax something or fill something out … You can’t just go to pick up your prescription and rely on getting an authorization on the spot.
Agent: Well, that’s just our policy.
MC: Are you aware that withdrawing abruptly from this medicine causes seizures, and if someone walks in and tries to pick up their medicine, has to pay full price, and can’t pay, the person could have a seizure?
Agent: Well, that’s just our policy.
MC: But that doesn’t make sense.
Agent: Is there anything else I can help you with today?
Main Character slams phone down and screams, then remembers she is supposed to go out for dinner with her partner, J, and his cousin at a nearby restaurant. (Main Character has scouted all nearby restaurants to see which ones can accomodate her insane food allergies.)
Main Character goes out with J and his cousin. She learns that J’s cousin, previously the picture of health, now has a ton of food allergies, so she doesn’t feel guilty about dragging him to the same restaurant as last time. She wonders if J’s cousin’s new allergies are related to some mold he found and removed from his home. She remembers that she didn’t finish “Cleanse Your Body, Clear Your Mind” by Dr. Jeffrey Morrison, which would have explained this.
When she and J return home, she notices a package that has apparently been delivered at 8 p.m. (The mail usually comes at four.) She has a sinking feeling. She opens the package. It is from OptimaRx, which has, in its infinite wisdom, sent her a three-month supply of generic gabapentin. She never uses mail order. She begins a long tirade, gesticulating wildly, while J and his cousin nod sympathetically and discuss the aggravation of dealing with health insurance. She notices a 24-hour customer service number inside the package and decides to call it. J and his cousin go off to get a drink.
MC: Hello, um, I spent hours on the phone requesting brand-name Neurontin, and you guys sent me a whole bunch of generic gabapentin, to which I am allergic.
Customer Service: Well, let me see if the mistake is on our end. If it’s not on our end there’s nothing I can do.
MC, Losing Her Shit: You sent me a three-months’ supply of medication I can’t take, and now I can’t get the one I CAN take, and there’s nothing you can do?
Customer Service: OK, it looks like your doctor called it in. Sorry, the mistake is not on our end. The doctor wrote the prescription wrong.
MC: I highly doubt that, because they were calling in an approval for the brand name, and I think something just got screwed up!
Customer Service: The full price for the brand name is $751.52. If you pay that, we can send it to you.
MC: NOOOOOOO!!! I CAN’T PAY THAT! I CAN GET THE BRAND NAME AUTHORIZED AFTER APRIL 1, BUT I’M ALLERGIC TO THE STUFF YOU SENT ME!
Customer Service: Let me put you on with the supervisor.
Supervisor: Miss, how can I help you … Miss, calm down … I don’t understand you if you are yelling and crying like that …
MC: (Wailing.) But I can’t take this medication, and now I’ll be in your system forever, and I don’t even use mail-order!
Supervisor: Okay, it does look like your doctor ordered it and then called to cancel the order, so I don’t know why this was sent out, but I will send you a special envelope so you can send it back to us. The prescription won’t go into your file as having been filled.
MC: Great! (Thinks a minute.) So what happens when I go and try to pick up my brand-name medication next week? Will I not be able to get it because they will say that I already got three months of the generic?
Supervisor: Well, when we get back the generic, the order will be out of the system, so you shouldn’t have a problem.
MC: But you won’t have the medicine back by the time I need to pick up the new one. If you’re mailing the envelope out today and using the post office, I won’t even get the envelope to send back the generic by the time I need to pick up my prescription. So it won’t go into the system as not having been filled, and the insurance willl just deny me the brand-name one at the pharmacy.
Supervisor: We can expedite it.
MC: Like how? FedEx?
Supervisor: Through the post office.
MC: ARE YOU KIDDING ME? I won’t get it in time and you won’t get it back in time. I have to pick up the brand-name drug this week.
Supervisor: You can have the pharmacy call our help desk and it will be in the notes.
MC: That NEVER works out.
Supervisor: Let me give you the help desk number.
MC: What is your name, so I can say whom I spoke with?
Supervisor: (Perhaps suddenly feeling sorry for Main Character.) OK, you know what? I’m going to help you out. My name is Jerry Montalves and you can call me directly, and here is my number. I am in Monday, Tuesday, Thursday, Friday, and Sunday from 12 to 9. Just have your pharmacist call me if you have any problem picking up the medicine.
MC: Thank you so much! I’m sorry you have to work on Sunday!
Supervisor: Thanks! I don’t mind it, except during football season.
Main Character hangs up, feeling temporarily grateful, planning to leave the guy’s number with Carlos the pharmacist, and hoping the name and number the guy gave were real.