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2002-06-25 | 9:59 a.m.

Have to do some work today. Been in a funk since last night and I need to shake it off. The whole thing with the dance teacher, of course, but it's more than that. I think one thing that's really bothering me is this unfilled prescription. It's making me very angry that the psychiatrist's office has been so blas� about resolving this problem. I think I might complain about them to my health insurance.

Here's what happened. Nine days ago I took my prescription to the pharmacy. Actually, I had to go to four pharmacies before I found one that could fill the prescription. Then I go back to pick it up, and it's not ready. The pharmacy staff are sort of funny, stand-offish, and secretive. Not like my regular crew at Walgreen's. They tell me that the psychiatrist needs to call the insurance company before they can fill the prescription. So I check back a couple of times, and nothing has changed (each time I check, it takes a small lifetime to get the information that nothing has changed). I call the psychiatrist's office and speak to his office manager, or rather, office manager #2, since office manager #1 is apparently on vacation for the week. Office manager #2, whom I have come to think of not so affectionately as the Mallrat, decides after a long chat that the pharmacist must expect the psych's office to ask the insurance company for prior authorization, but she knows "for a fact" that this particular drug does not require prior authorization. "I could put it in," she says, "but I can tell you right now they won't do anything with it, because it's not required." I ask her if she can send it in anyway and she reiterates that "it won't do any good."

I call the insurance company and I get redirected about 5 or 6 times, not counting the times I am disconnected because the transfer didn't go through. I talk to a very nice fellow who says he understands the situation perfectly and he will call the pharmacist.

I figure it's all settled, and a few hours later, I stop by the pharmacy to pick up my prescription. It's not ready. I ask the pharmacist if the fellow from my health insurance company called, and he said yes, but the pharmacist has subsequently deduced that "he was wrong."

Even though I am the least informed person in the bunch, it is clearly going to be my job to make sure this gets resolved, because nobody else is going to go to bat for me.

I call the psych's office again and ask her if she will call the pharmacist. She doesn't want to. I ask her what I should do, and she asks the psychiatrist, who replies, "Just tell her to go ahead and pay for the prescription and then get reimbursed for it later."

Arrrrrrrrgghhh! I hate when people think I'm poor-mouthing when I'm NOT. "I'm perfectly happy to pay for it," I tell the Mallrat through gritted teeth. "But the pharmacist refuses to FILL the prescription without authorization."

"Oh," the Mallrat says. She's not going to help me at all.

At home that night, I ask Duff if there is anybody at his company who can help me out. An ombudsman who can deal with the insurance company as my advocate. After all, it's a big company. Surely the insurance company would take them seriously; would help sort out the problem.

"No," Duff says. "There really isn't." (Subtext: "No, I've never heard of anything like that, and I'm not going to stick my neck out and ask, either.)

So I get back on the horn with the insurance company. In fact, on the long drive to Felony's dance recital dress rehearsal, I make eleven calls to the insurance company, trying to get to someone who can sort out this problem. Eventually, my question refines to this: Does a prescription for Adderall require prior authorization? And eventually, I reach someone who knows the answer: Yes, it does, for anyone over the age of 18.

A-HA! That's it! No wonder the Mallrat didn't think it required prior authorization! The psychiatrist is a pediatric psychiatrist; he only takes on the occasional adult for evaluation. She's used to him handing out kid-scripts ten times a day, no problem. I am energized by the revelation, and immediately call and leave a message at the psychiatrist's office explaining everything in a manner as polite and non-accusatory as I can make it. I even leave the phone number for the right person at the health insurance company.

That was about four p.m. on Wednesday. At about four p.m. Thursday, I call the psychiatrist's office to follow up, and I talk to the Mallrat. Yes, she got my message, she says crisply. Clearly, she is mad at me. I guess she thinks I am calling too often. She says she will put the request for authorization in, but, she doesn't think she'll have time to do it before tomorrow morning. She says, "I want to warn you that it takes a really long time." She makes the process of sending a fax and having it returned sound like the pony express. I do not explode with anger, even though what I'm feeling is, hey lady, don't let me rush you. I've just got my whole life on hold here wondering if things are ever going to get better for me, and you are doing I-know-not-what that will prevent you from doing this, which is indisputably part of YOUR fucking job, and no favor to me whatsoever.

After I get off the phone with her, I immediately call my knowledgeable contact over at the health insurance company. (I realize that I've memorized her number.) I ask her how long it takes for this process to go through. She says 24-48 hours. Assuming Mallrat gets the fax done Friday morning, that means I should have my prescription filled by end of day today.

But I know it probably won't happen that way, because nobody involved in this scenario cares except me. It all falls to me, and one thing that really bothers me about all this is that having to make all these phone calls trying to get the prescription to go through makes me look like some sort of deranged junkie jonesing for a fix.

So that's that. Pretty soon I will call the health insurance office again to find out if the prior authorization request ever came in. And they will probably tell me no. So then I get back on the merry-go-round.

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