The Journey to Resolution

June 17 1:30pm

Posted story to http://www.drcatherinerose.com blog, Facebook and Twitter.  In Twitter post, included @Cigna and @CignaQuestions

June 17 9pm

Sent emails to executive teams at Cigna, Care Centrix and Apria.

Subject of Email: “Can Cigna/CareCentrix/Apria help keep my daughter out of the hospital?”

Received emails back from Cigna leaders at 9:30pm, 7:45am (Jun 18) and 9:45am (Jun 18)

June 18 9am

VP CareCentrix called cell phone to tell me that a team of nurses are working on this case right now to get straight answers for your questions.  I apologized for having to escalate it like this and that it’s not my normal behavior.  She said that no apology needed and that she appreciated my patience as they worked through getting straight answers to get what my daughter needs. It was truly a pleasure to hear her speak calmly and clearly about how they were going to work to find resolution.  She even gave me her name clearly, her office phone number and her cell phone.  She assured me she would call back at the end of the day to discuss the resolution.

June 18 12pm

Cigna contact sent me an email confirming that Nestle Dairy Nectar Thick will be covered. She indicated that she’s working with Carecentrix (who also working with Apria) to expedite the request for it.

June 18 1pm

Apria contact called me verifying shipping address for the Pediasure 1.5cal and saying that the necessary paperwork was put through for the authorization on the Nestle Dairy Nectar Thick.  But there was an issue that the prescription was outdated and the last time this was provided was Dec 2012 (An aside:  my blood pressure increased at this comment – because this is what started it all – they discontinued a delivery that Alexis had been getting for 2 years in Jan 2013 without any clear explanation.  I said, while the latest prescription was faxed in mid-May, that it is in their system because they’ve already rejected it.) She hunted, she found it and told me she’d need to send this one back for reauthorization with CareCentrix so they can guarantee it will be covered.

[I return to work… wondering if this will get done today….]

June 18 4pm

Apria calls back to tell me that the reauthorization for Nestle Dairy Nectar Thick was put authorized and should arrive Monday.  The Pediasure 1.5 Cal shipped today and should arrive Friday.

June 18 5pm

VP from CareCentrix called to confirm that everything was resolved in terms of the thickened formula and the Cigna case manager was going to follow up with me to explain how the original denial was a coding error that had been corrected. She apologized again.  I thanked her for her hard work and appreciated the service.

So I’ll be sharing on Facebook, Twitter and my blog: drcatherinerose.com the arrivals of Pediasure 1.5Cal and Nestle Dairy Nectar Thick

My real curiosity in all of this mayhem is – it took 3 companies about 24 hours to rectify something that I had been hassled with since January. I feel like I had to throw a 2-yr old temper tantrum to get their attention.  In the end, the method worked – but shouldn’t it be easier to work with companies providing healthCARE benefits that in so many cases are lifesaving for our kids.

I think my Facebook friends summarized it well with their comments:

  • Reading this has my blood boiling. Why is it that parents have to fight for their child’s survival?
  •  NOTHING is more frustrating than getting the run around, especially when your child’s life is essentially at stake. Bureaucracy at its best.
  • Do they think you want this stuff because it is much more fun to have your child have special dietary needs vs eating regular food??? I am so frustrated for you.
  • I’m so sorry you have to deal with this. I would be angry too.
  • My son was pretty much DENIED services because of the primary healthcare coverage he had.
  •  I am appalled. This is so RIDICULOUS. I am seriously angry for you right now. ARGHH!!! Good luck sorting this out. So sorry it happened in the first place.

I am not alone in this suffering. And I will work to make sure that our voices are heard to make this work better from the patient’s and caregiver’s point of view.

Sorry to drag everyone through this – but if I can be an example of hope – that resolution from 3 companies can happen in 24 hours – I like that.  As I said, I do not like having to resort to a temper-tantrum to get services covered – but when a saga continues for 6 months with constant circles – I saw no other method.

Would love for organizations and people to step forward for putting patients and caregivers FIRST (really first, not just PR).

Catherine

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Posted on 06/19, in Uncategorized. Bookmark the permalink. 1 Comment.

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