Complaint Review: Anthem Blue Cross (Ohio)

 On 09/03/2013 I left work abruptly due to excessive vomiting and some other symptoms. I was able to see my primary physician that day and found out I had an intestinal infection from food poisioning, I was ordered to 2 days bed rest with prescriptions for nausea medication along with an antibiotic. The nausea medication was given to me so I can get the antibiotics down... I was also given a prescription for a new inhaler for my asthma (proair). I recently switched to Anthem Blue Cross through my employer, so I've only been enrolled for two months now. I went to the pharmacy yesterday to pick up my prescriptions only to be told they were not ready because Anthem needed a prior-authorization, okay so I asked the pharmacy what could I do to help speed up the process because I could not afford to miss more than two days of work. She said I could contact my doctor to let them know... Not sure why I was told to do someone elses job but I went along with it, so few hours later I call again and nope nothing no prescriptions ready and my doctor's office claims they spoke with the pharmacy to okay it. But somehow Anthem was still invovled at this point and was still denying to pay for their portion of the prescripstions (which may I remind I missed two days of work and could not afford to pay out of pocket for these prescriptions).

So I called Anthem yesterday at about 3:39 P.M. EST, mind you I have been very adamant at this point to rest and get what I need to get back to work... Spent an hour on the phone with some brain dead high school drop out, who could not give me a definitive response as to why they were holding up this fairly simple process. I was originally told by this woman that my ProAir was not covered because my asthma was a pre-existing condition and I would be responsible for the payment in full... First problem, I have a book issued to me by the third party (that shall remain nameless) who sold my employer this insurance that begs to differ, it clearly states there are two types of waiting periods if you were not COVERED in the past 12 months by a health insurance policy. I had Medical Mutual of Ohio for over 3 years and so I obviously did not fall under these special circumstances. Then I was told only a certain milligram dosage of the nausea medication was covered and my physician requested for me to be given a whopping total of 6 pills.. So they needed once again a prior-authorization for CVS to fill the prescription. The antibiotic was simple it was covered but I wasn't able to take it because I was violently vomiting for the majority of the day... Hense is to why I needed the nausea medication. I was encouraged by the insurance company to always bring my book to the doctor to avoid this problem, ummmm excuse me?! No Doctor has the time to read through lengthy insurance mumbo jumbo to help avoid a longterm headache for their patient.

PriorAuthorization, is a misleading phrase used by health insurance companies who want to avoid having to pay for a portion of your prescription. I was told today (09/04/13) on the phone during my second call to Anthem Blue Cross to complain about their services, that some drugs that are frequently abused require this special second authorization. This is understandable, however I do not have a history of drug abuse, never been issued any prescripstions for narcotics or methamphetamines. Interestingly enough I went through the list of different common prescription drugs issued in my Benefits book from Anthem, and there are several drugs that fall under the commonly abused category that do not require PriorAuthorization. (According to their key listed at the bottom of the page) Just to name a few...

*Adderall XR *Lorazepam *Methadone *Methamphetamine *Morphine Sulfate *Oxycodone *Oxytocin 

*Phenobarbital *Phenyleph/Chlorphen *Promethazine/Codeine *Promenthazine/dextromethorphan 

*Seroquel Xr *Dilaudid *Opana (Some might I add made the 10 ten drugs abused in America for 2012)

I would also like to add I take birth control called Loestrin 24 FE which is listed as a Tier 2 prescription with Anthem and I had the option to pay $40 for this good birth control, but was told by an Anthem representative I could not have that specfic birth control if a generic was availble, problem is there isn't really a generic available, and secondly my insurance card says I could pay $40 dollars for it... So why all the misleading information. 

My simple ARGUMENT-------> My health care coverage costs me $154.68 a month, why should I have to do the leg work between my pharmacy to my primary physician that I am paying my health insurer for? 

Why should be encouraged by the Obama Adminstration to purchase health insurance through my employer or a private insurer for that matter if as a consumer I am not going to be treated with urgency? Or with integrity for that matter. 

Why should I pay for health coverage to go to the Doctor and pay a $30 dollar co-pay only to be turned away at the pharmacy at the discretion of my health insurance company? What was the sole purpose of seeking treament for a health related issue if your not able to get your medication?

Why should any citizen in this country who is having health insurance related issues, be written off with a simple apology from any insurance company? Sorry doesn't cut it America! 

It is now the second day, and I will be returning to work with no antibiotics for my infection, and no inhaler incase I have an attack. I promise if I do suffer an asthma attack I will sue the pants off of the CEO at Anthem Blue Cross. This will not end here, I will be writing my Senator so that he can also add this to his list of health care related issues that need reform.