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Learning the hard way

May 19, 2015

I’m climbing on my soapbox again to speak my mind. This time, I want to tell you about a medical-insurance problem I had a few months ago.

The problem started in November, when I enrolled in a Medicare Part D plan sponsored by Silverscript, which would be effective in January. I selected the Silverscript plan after learning I could add it to my retiree prescription insurance through Southern Company. Had I chosen a different Medicare Part D plan, I would have had to drop my Southern Company prescription insurance.

In early January, I called Silverscript to refill my prescription for Ampyra, a medicine that helps me walk. Ampyra is the only FDA-approved product “indicated to improve walking in patients with multiple sclerosis,” according to the Ampyra website.

I have taken the drug for five years and am accustomed to getting the prescription filled by the CVS/Caremark specialty pharmacy in a day or two. In this case, I was unable to get the medication for 60 days. I spent hours during January and February talking with customer service representatives from Silverscript, Ampyra, CVS/Caremark and Southern Company’s benefits service center, trying to resolve the problem.

By the time I received a month’s supply of the drug in early March, I had fallen and fractured my pelvic bone in two places.

Here is a sample of the problems I encountered:

  • Silverscript quoted me $750 for a month’s supply of the medication. (I had previously paid $40 a month.)
  • When I balked at the price, Ampyra suggested I apply for an income-based Prescription Assistant Program. Thirty days later, I called and found I had not been approved for the program.
  • During subsequent calls to Silverscript, I realized that the company was unaware of my Southern Company insurance coverage.
  • Then, I was told Silverscript couldn’t file a claim for the medication, because both plans were listed as my primary coverage and neither as secondary.
  • When I resolved those issues, I attempted again to fill the prescription. Silverscript told me I would have to pay $750 out-of-pocket when they filed the claim. After the claim was finalized, I would have to file a separate claim with Southern Company. After the second claim was finalized, I would be reimbursed $690 of the $750. (Good news: The prescription would cost only $60.)
  • On the advice of a rep at CVS/Caremark, I asked Silverscript to coordinate the benefits on the claim so I wouldn’t have to pay anything out-of-pocket. The rep at Silverscript agreed. (Sometimes, you just need to know what question to ask.)

In retrospect, I was pleased with my experience with the customer service reps at CVS/Caremark and Southern Company’s benefit service center. They were instrumental in resolving my issues. But the reps at Ampyra and Silverscript – not so much. It seemed they lacked the knowledge and ability to help me.

The good news is that after two months back on Ampyra, my walking ability has begun to improve. The bad news is that the injury to my pelvic bone, which has not healed, makes walking painful and difficult. My doctor has ordered me to rest and limit exercise.

It may be another month before the pain subsides and I can resume my normal activities. Meanwhile, my lack of exercise has weakened the muscles in my legs, so I will need physical therapy to strengthen my legs again.

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One Response to “Learning the hard way”

  1. sgraphos1028 Says:

    It is really a wonder that you didn’t go crazy(er) throughout that process! For Gods sake, I mean there’s not enough wine to handle this!!

    Liked by 1 person


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