I’m watching The Andy Griffith Show and I’m tearing up. It hasn’t been a great day. I’m crying because it has been a mentally exhausting day dealing with the seemingly unnecessary rigor of navigating our modern American healthcare system. I am longing for a simpler time like I see on my television screen. I am watching the episode tonight where Mr. Tucker, the busy businessman from Charlotte, NC comes through Mayberry with car trouble and is so wound up about the delay that he can’t appreciate the kindness and slower pace offered by the small town.
A Day in the Life…Navigating the American Healthcare System
My daughter just moved across the country, from North Carolina to Colorado. That was fraught with plenty of stress and worry as any mother can relate to. However, it seemed a very simple proposition from speaking to our health insurance administrator to transfer her prescriptions to a new pharmacy in a new state. We would simply have to go to Human Resources a week before her move and change her address. They will then ensure that her health coverage will continue and a new network will be set up for her in her new location. Sounds great, simple enough.
My husband went to HR, two weeks ahead of time and was told that actually he has to do that online. This is no problem, we did that, easy enough. Task complete, or so we thought. Two weeks later, she has moved and my husband calls the insurance company again. They say that actually they haven’t received the new address information from HR. This is a problem if my daughter wants to get her prescriptions refills.
The Only Other Thing You Need To Do
The nice woman on the insurance administrator’s 800 line says she will put in an urgent request for her information to be sent to them for update. She calls back later to say they have received the information. Thank goodness. It’s been two weeks, but it is now taken care of. The “only other thing you need to do is call the pharmacy benefit administrator to verify that they have also have the new address, which they should have later today”.
Okay…still hoping this can be resolved quickly. My husband calls the 800 number, as instructed and he gives them our insurance information. The somewhat frazzled woman on the phone reveals she is working out of her home and is frustrated with “this thing” (the computer) and says she can’t find any information on our daughter because his Medicare part D doesn’t cover children. My husband isn’t on Medicare.
The HIPAA Release
He ends the call with that customer service representative. He calls back and speaks to someone who is able to pull up our correct insurance information but is told that they can not discuss anything about our daughter’s pharmacy benefits because she is over 18. She will have to call back to give a HIPAA release before we are allowed to speak on her behalf. No problem, we call our daughter. She is a little overwhelmed herself with all the changes and “adulting” but she will call the number and make the HIPAA request. She calls, but the representative says her information can’t be found in the system at all, even with all the information on her insurance card.
Time To Regroup
It’s time to regroup. Maybe we can just go online and deal with this? I go to the prescription part of our insurance plan online, check the available pharmacies in her zip code and find that indeed there are 19 pharmacies within 25 miles of her zip code that are in the important “network”. I relay the information to her and she chooses one of the pharmacies to have her prescriptions refilled. A quick call to her doctor in NC and she is able to get new prescriptions called in to her new pharmacy in Colorado.
I Can Still Hope
Okay, maybe this will work out. But, sadly, no. Her new pharmacist says her “BIN” number was “kicked out”. The pharmacist calls the insurance company to try to get resolution but to no avail. At this point, we have one hope. The insurance company was to have sent her a new card two weeks ago but it never happened. They have sent her a new card now, we are assured. Is it actually in the mail? Will it have a different number on it that won’t be “kicked out” of the pharmacy system? I don’t know, but I can still hope. My daughter is going to run out of her medications. She calls me while leaving the pharmacy and I can hear the strain in her voice. She was able to pay out-of-pocket for the one medication she had actually run out of but couldn’t afford all three.
This is what it’s like to navigate the healthcare system in our country now. It seemed like such a simple issue. If we lived in Mayberry, back in the day, did they worry about things like this? They don’t seem to have these kind of problems. I fantasize about living in Canada or Britain where they don’t seem to have to worry about a healthcare system like this. It is especially stressful to feel so powerless when it is your child.
A Spot On Andy’s Front Porch
Mr. Tucker, in the Andy Griffith episode tonight, finally succumbs to the slower paced life on Andy’s front porch in Mayberry. He decides to delay his return to his hectic schedule in the big city of Charlotte for one more day. I want to be able to get off this ride as well and slow down but I don’t know how. So, my tears come again. Can I pack up and relocate to Mayberry? I’m tired from dealing with the minutiae of this American modern life. I just want a spot on Andy’s front porch even if it’s for just one day.
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