Unhealthy insurance - Part 2 The saga continues Mishandled Rx is SOP* AvMed, Humana: Are you listening?

 

This entry unfortunately is a continuation of the Humana and its docs rant posted Wednesday, August 6, 2014. This time Humana Customer Service gets a gold star.

WEDNESDAY, JULY 30, 2014

On Wednesday, July 30 I gave the people at Leung Healthcare in Hollywood FL - I can't write "my PCP's office" since I now am relegated to seeing a physician's assistant (PA) and no, PAs are not RNs - a request, written in large letters, for four (4) prescriptions. Each was to be for a 90-day supply. To my Edward Bear mind, that was a pretty simple request.

Apparently the request was too complicated.

I need four (4) prescriptions.

* Send ZXY prescription via fax to RightSource.

* Hand me the remaining three (3) prescriptions and I will get them filled locally.

Only one (1) prescription was to be faxed to RightSource, Humana's contract mail order pharmacy. I spent many years as journalist and technical writer so I believe I know how to write clear and unambiguous English.

Three prescriptions were to be handed to me so I could take them to my local pharmacy (Publix) which dispenses two (2) of my meds gratis; no charge to me or to Humana.

RIGHTSOURCE HISTORY

RightSource has received the Rx for one of my meds three times.

The first time the order (from another practice) was filled promptly and correctly.

The second time my then PCP, proving he either can't count or won't listen, ordered 240 capsules. I take four capsules a day. By my math, that comes to 360 (30 capsules * 4-a-day = 120) * 90 days =360 capsules).

WEDNESDAY, AUGUST 6, 2014

On Wednesday, August 6, 2014, I called the practice and asked if my three (3) prescriptions were ready.

To paraphrase, I was told: "Well, gee, I can't find anything. Maybe they were sent to RightSource. Why don't you (the patient) call RightSource and check?"

I refused to call RightSource, telling the office person she should contact RightSource and get back to me before the end of the day. Today is Friday, August 15, 2014 and I still am waiting to hear from anyone at Leung Healthcare.

THURSDAY, AUGUST 7, 2014

Today, Thursday August 7, 2014, I received a package from RightSource.

And the snafu - that's accurate because this obviously IS the normal situation - continues.

Inside the package from RightSource were three (3) bottles of pills.

Two bottles contained a total of 180 pills which are taken one pill twice-a-day - a 90 day supply. (Yet, the bottle shows I have THREE (3) refills remaining.

The third bottle contained 90 pills of a one-a-day medication; a 90-day supply. This medication's prescription also was supposed to be handed to me. As with the earlier prescription, there are three (3) refills, so I'll be good for 120 days. According to Hozba.com there are less than 140 days until December 31; unfortunately that means one more trip to Leung Healthcare. Unless, of course, if there is another foul up not yet discovered- or I decide to skip 20 days between now and the end of the year.

The third "hand the patient the prescription" has yet to arrive.

The fourth prescription, the one that was supposed to be faxed to RightSource also was missing.

Did RightSource get the scripts? Will I get the remaining meds before running out in another few days.?

The first time RightSource sent a mail order it sent a 90 day supply - 3 containers, each with 30 days' worth of pills. (How did it happen that RightSource got it right? Different prescribing doctor; different practice.)

PAYING FOR LEUNG HEALTHCARE'S MISTAKE

Humana was charged $13 each for two prescriptions that I normally get for free - no cost to me or Humana - at Publix. While the $13 is not going to break Humana, the real issue , is that these charges get me very close to Humana's maximum annual allowance for prescription medications. (Humana's maximum is in line with other Medicare Advantage providers; the limit is not the issue - REACHING THE LIMIT is the issue.)

At the end of the day - the day being Thursday August 7, 2014, I am left wondering if tomorrow's mail will bring the rest of my meds and will the delivery contain a 90-day supply of two meds and, maybe, an 80 day supply of the medication for which I so far received only a 30 day supply.

TUESDAY, AUGUST 12, 2014

Letter to Dr. Gilbert Leung, the physician who owns Leung Healthcare, setting forth my problems with his Hollywood practice. I noted that I now am out of one critical medication (due to the pervious script's mishandling). I also related my communication with the office staff in trying to resolve the issue. This is my third (3rd) letter to Leung or his wife/administrator; none of which to date have received the courtesy of a reply.

THURSDAY, AUGUST 14, 2014

The third of he four medications arrive. As with the previous two (see Thursday, August 7, 2014, above), this 90-day supply shows "3 Refills before (date).

I still have heard nothing from Leung Healthcare - neither it's Hollywood office nor its owner or his wife; this cavalier attitude is most "off-putting."

How did "cavalier" morph from "horse soldier" to "don't care attitude?" (See bottom for Merriam-Webster's definitions.)

FRIDAY, AUGUST 15, 2014

HUMANA, in a response to a web-mail message I earlier sent, informs me that "RightSource does not have an active prescription for (medication) on file." RightSource got scripts for everything BUT the most critical medication, the one medication I told the people in the Leung Healthcare office to fax to RightSource.

Humana gets a gold star for tracking down what Leung Healthcare SHOULD have done two weeks previously.

Are all medical offices so badly run?

Last year I was with AvMed and I had an excellent PCP by the name of Edwardo (Eddy) Perez-Stable, a/k/a Dr. P-S. Unfortunately, the office staff almost never anything it right. (My wife still sees Dr. P-S - different insurance - and reports that the office still manages to mess up simple tasks.)

AvMed, in its questionable wisdom, dropped Dr. P-S' practice and, in a fit of pique, I dropped AvMed and signed on with Humana.

On first blush, I thought the practice where I reluctantly now go had a first rate office staff. A façade; this group is no better - and possibly worse - than the staff that is supposed to support Dr. P-S. (AvMed also lists Leung Healthcare.)

 

Rx = Prescription, script (Yes, the graphic is deliberately upside down.)

SOP = Standard Operating Procedure

CAVALIER According to Merriam-Webster's online dictionary, "cavalier" as a noun means " a gentleman trained in arms and horsemanship" and dates back to at least 1589. "Cavalier" as an adjective id defined as "marked by or given to offhand and often disdainful dismissal of important matters"; this dates to at least 1641.

Wikipedia gives an interesting background on how the word was associated to Merriam-Webster's adjective definition.

Unhealthy insurance Humana and its docs Raise my blood pressure

 

I'm frustrated and my blood pressure, already high, is going to stratospheric levels.

Why?

Glad you asked.

I am a geezer on Medicare. My Medicare Advantage provider is, until December 31, 2014, Humana, specifically Humana Gold Plus (HMO).

My PCP is Leung Healthcare, a multi-office practice in Florida's Broward and Dade counties.

I signed up with Leung after my first Humana PCP refused to refer me to my long-time ophthalmologist who is a Humana practitioner. That boggled my mind - a Humana PCP refusing a referral to a Humana specialist.

IN ANY EVENT, last week I visited my PCP's office. I gave the office folks two pieces of paper.

One piece was a form from RightSource, the mail order pharmacy that contracts with Humana. The instruction was very clear - order ONE 30-day supply with two refills (total 90 day supply) of a specific medication. RightSource normally sends all 3 months in one package.

The other piece of paper instructed, in 14 point text that I needed three (3) separate, individual prescriptions for three additional medications. Each script (prescription) was to be for a 30-day supply plus two (2) refills for a total of a 90 day supply. I take the three meds I wanted prescribed on separate prescription blanks to local pharmacies; two of my medications are free from Publix, a local high end supermarket.

OK.

Leung's sole doctor - the nearby office is advertised as a two-physician practice, but this has not been true since early 2014 - has twice managed to mess up my meds. For that and other reasons I now avoid the practitioner and see a "certified" physician's assistant. In Florida, a physician's assistant is not required to be a registered nurse (RN). It's bad enough when a patient is seen by an Advanced Practice Registered Nurse (APRN) although, if truth be told, I've known some RNs who were better diagnosticians than the doctors for whom they worked. Still, a "PA" is a long way from an RN and even farther from an APRN. I wonder if Human is billed for a physician's visit.

About 5 days pass and the patient - this scrivener - calls the office to check if (a) the one script was faxed to RightSource and (b) if the three (3) scripts I will fill locally are ready to be picked up. (Never mind that the office should have called me.)

Because my meds previously were mishandled, the scripts no longer are in synch so I get the prescriptions filled when needed. (Insurance carriers make sure I do not get any meds ahead of time; no objection to that.)

When I asked about the three scripts that I specifically requested be written (again, 14 point text) I was told "I think they were ordered through RightSource."

I was told that I could call RightSource and check. I declined and asked that the practice office contact RightSource to find out where are my prescriptions. I didn’t send them to RightSource; I don't know who to contact at RightSource. Bottom Line: Not my job.

I TRIED to share this with Humana.

After all, Leung is a Humana practice and having the prescriptions filled by RightSource costs Humana more than having the prescriptions filled at Publix.

I can contact Humana several ways - via "social media" or through an on-line form. I don't have - nor want - Facebook or Twitter or similar "social media" accounts so that is out. I have managed to contact Humana several times via the on-line form, but not this time.

I tried with Chrome. I tried with Explorer. Neither could open the form. There was zero indication that Humana's system was sick and that I should try again in "n" minutes/hours/days. Click on Compose Message and nothing happens.

The end of the calendar year nears and I'm already looking for a new PCP and possibly a different Medicare Advantage carrier. So far I've found four (4) prospective Advantage providers - Aetna, AvMed, Cigna, and Humana. (The criteria is listing my vascular surgeon; if Jeffrey Hertz is absent from a provider's list, I move on.)

I have experience with AvMed; it was mostly positive and, had it not cancelled my former PCP's contract, I'd still be with AvMed. (To be fair, my former PCP's office staff never seemed to get anything night the first time; sometimes not the second or third time, either.) If I had a problem, I knew who - and how - to contact at AvMed; not so with Humana. I have zero experience with Aetna or Cigna.

I have reason to believe that Humana has a robot that scans blogs and "social media" for certain words - "Humana" being the primary word - so perhaps - perhaps - this rant will get someone's attention at Humana.

I know I can change my PCP at the first of any month, but since I anticipate visiting my current PCP's office only once more before year's end, I can (hopefully) "live with" Leung Healthcare's certified physician's assistant (in lieu of the second physician advertised for the local office).

One thing about Medicare: it's an education. I've learned there are many questions to ask both the Advantage provider and the prospective PCP. Although a patient can change PCPs every month (not advisable), the geezer is "stuck" with the Advantage provider (e.g., Aetna, AvMed, Cigna, Humana) from January to December.

MEANWHILE, if anyone has experience with Aetna or Cigna Medicare Advantage programs, please contact me via email: JohnGlennMBCI at gmail dot com.