"It could be raining"

I freely admit to knowing the entire dialog of "The Godfather" first and second film. I also know "Young Frankenstein" start to finish. There are a few more I could add to the list but I want to maintain some semblance of maturity. I have been a movie aficionado as long as I can remember.

In "Young Frankenstein" Igor and Victor are digging in a cemetery. They are up to their necks in a grave site when Victor says, "What a filthy job" Igor, "Could be worse," Victor, "How?" Igor, "Could be raining." And, of course, it begins to pour. This was pretty much how I felt Friday.

If you want to hang in and read all of this be my guest. If you would like the condensed version feel free to skip down to the last few paragraphs.

Once a month I need to visit my doctor for a routine check and follow up prescription refill. Obviously, it would be much easier if I could do this less often, maybe once a year. I'm sure the reason I go every thirty days is cost, the medicine is very expensive. The insurance company wouldn't want me to get hit by a train, or struck by lightning with a supply on hand.

For a time in my nursing career I worked as a medical case manager. The job description made me sound like I was helping injured workers. After starting I learned I was supposed to help the company. I didn't like it and didn't do it very long. However, I did learn how to get around the system.

I have been dealing with the pharmacy in the grocery store for years, they open at nine. Friday, I needed to fill a prescription and we needed to do some shopping. We split up, I to the pharmacy and Wanda elsewhere. There is a great sale on a certain brand of milk, the store is out. I heard my name while I was talking with a dairy guy.

When you hear your name on the P.A. system in a supermarket you can be fairly certain it's not because you won the lottery. I was called back to the pharmacy because, as a staff member said, "First Script no longer handles your prescription benefits." I asked what that meant in real speak.

As of May 13th First Script "lost" the contract for my insurance carrier. They have no information other than, contact your claim manager, attorney, or employer. (Insert here: I need this medication) We still needed, cookies, fudgesicles, a couple of artichokes and a frozen entree (free from Finney's Free Friday on ABC). I asked Wanda to finish shopping and I sat on the frozen food section floor and began to hyperventilate.

Several shoppers passed, staring at me, or attempting to do bodily harm with their carts so I went out to sit in the car. It was now 9:45, I had all day to try and understand what was happening, or not happening.

The first thing I did when we got home was call my doctors office. Surely, they would know something. I was very careful to "listen to the entire recording as our menu has changed" I was confused and hit zero for the operator. She said I would need (at this point all names have been changed to protect the innocent and because I can't remember them) "Susan" and sent me to her, voice mail. I went back to the operator.

Me, "I really need to talk with "Susan" but got her voice mail." Operator, "that's because "Susan" isn't in her office." I almost asked why she transferred me there but didn't want to piss her off. Operator, "she is in now, I'll connect you." She did and I got, her voice mail. I left a short, urgent message around ten yesterday morning. I'm still waiting for a return call. They don't work on Saturday, or Sunday, I will not hold my breath.

I called the insurance carrier. Given a number to call, I thought it was the new prescription coverage place. I reached the California Insurance Guarantee Association. "Alice" asked me questions and connected me to my new agent, "Hank" I got his voice mail. I transferred back to "Alice" who then transferred me to "Joe" who was a manager and could help me, I got his voice mail.

Now I was contemplating leaving a message on my voice mail. I have call forwarding and speed dialing on the home phone. Maybe I could have my voice message call their voice mail? I could not do this so I called both "Hank" and "Joe" again. Now, "Joe" was at his desk. I was about to be enlightened.

The California Insurance Guarantee Association is not a prescription management company. They are a state run agency that, "operates under the insurance code to provide a mechanism for the payment of covered (as defined by the Insurance Code and specific case law) property, casualty, and workers' compensation insurance claims of insolvent insurance companies."

In real speak: I just realize, my insurance carrier went "belly up" or "under" they "kicked the bucket." Probably, after years of earning obscenely large profits the bean counters saw red. It's now close to two and I'm no closer to a resolution. "Joe" tells me I really need to talk with "Hank."

I talk to "Hank" at three. Here is what I learn. Four hundred and fifty people were left blowing in the wind. The old company that was providing payments for treatment, prescriptions, cost of living and/or any type of financial settlement was gone. The doors were closed, the file cabinets empty. This CIGA was taking over all the cases.

"Hank" was my new agent. He had my "file", it was one hour before quitting time, he lives in southern California and it's Friday. I currently have a three day supply of medicine. "Hank" tells me to go to my pharmacy and have them call him, so, we do. It's only a mile or so and earlier we forgot the cookies and fudgesicles.

Three twenty at pharmacy counter I gave "Sylvia" the agents information, she called and got, voice mail. Ten minutes pass, and like a schmuck, I actually think this will get resolved by four. "Hank" finally called back and gave "Silvia" the phone number of "Elm Care." Elm will be doing the pharmacy payments and billing for CIGA.

The scenario now is, "Hank" talked with "Elm Care" and "Silvia" who is going to call "Elm" and get authorization to fill my prescription. "Silvia" called "Elm" and got an agent who has no idea who I am or what she is talking about. At least she didn't get voice mail and it's not raining, yet.

Another twenty minutes pass and we are still spinning our wheels. In five minutes my agent is off for the day. "Elm Care" only bills electronically and can't do that until "Hank" gets my file in the CIGA system. Prior to getting my info in the computer, CIGA would authorize payment but it isn't set up for e-billing, just paper. My pharmacy only uses e-bills.

I got on the phone with "Hank." "The place where you are," he tells me, "only e-bills." (I already was aware of that). "However, we deal with Walgreen's and CVS all the time and they will paper bill." "Hank" told me to go there, give them all my information then leave him a detailed message or e mail. As soon as he is in at seven Monday he will contact the pharmacy.

Walgreen's and CVS deal with CIGA "all the time" and they send "paper bills" all the time and I need to go there. I called Walgreen's and spoke with a pharmacy staff person who said, "we don't send bills, everything is done electronically." I was going to tell her "Hank" said they did but knew that would be a waste of the time I had so little of. I decided to try CIGA one more time.

I called a CIGA department manager, she said, "We deal with Walgreen and CVS all the time and they send paper bills." I told her they weren't aware of that here. Then she said, "I'm sorry, I just closed my system, it's five o'clock and I'm about out the door." No point in asking why she bothered to answer I told her to have a good week end. It was just after five, I don't drink cocktails so, I had a cookie. And, like Scarlett O'Hara said, "tomorrow is another day."

This morning Wanda went to a big neighborhood garage sale. I went to the local Farmers Market and stopped at Walgreen's on the way home. I thought talking to a pharmacist would help, it didn't. He was very understanding but they only e-bill. He suggested I go back to my regular place and see if they would work with me.

I drove to my regular pharmacy and spoke with "Ivan" the manager. He said he may be able to cover me for a week so I don't run out of meds. I will talk with him when they open Monday morning at nine.

I came home, called our local CVS store, they don't send paper bills either.

For those of you that skipped the whole story, in a nutshell, I have no pharmacy coverage. Once I am in the CIGA system (which could take a day or a month) their sub contractor "Elm Care" will send a pharmacy card and I will be covered. Until I am in the system CIGA will pay my pharmacy bills, but, they are not set up to e bill. Although the CIGA people tell me there are pharmacy's that send paper bills, I can't find one. 

I sent an e mail and phone message to "Hank" my claims adjuster. First thing Monday morning I hope to find a temporary fix and a permanent one soon after.

Four hundred and fifty people. Four hundred fifty people were not notified their relied upon medications, or money, or health care is gone. Heart and blood pressure medication, insulin and anticoagulants. "Hank" told me all this was "dumped" on them just the other day. He also said I was only the second person he has talked with. I hope that whatever I accomplish on Monday helps all those behind me. I don't mean to be dramatic but, there are life altering medications people need. This is really and truly a mess, but, it could be worse, it could be raining.