I’ve given up. Not given up hope, but given up trying to talk to Aetna. The manager we spoke to Wednesday and called back and left a voicemail with Thursday returned my call yesterday afternoon. More than an hour later, I was a wreck of a human being.
I was moments away from speaking to the President – Mark Bertolini – when his screener said “she was supposed to have taken care of this for you,” and transferred me to someone who said the plan I was on showed Pulmozyme as a Tier 2 med on a 3-tier open formulary plan. The system says I’m on a 4-tier plan, so Pulmozyme is a Tier 4 “specialty drug” and I was never able to get that other manager on the phone again because I didn’t get her ID number.
I’ve relinquished my control of the situation. I clearly can’t do anything to help things with my existing plan, so my brain and emotions have turned a corner to new ideas. I have not just sat idly by and let this happen to me; just the opposite – I’ve worked the situation until I was shaking and talking like a crazy person.
Now I have to let the system (the insurance regulators) do its thing pursuing the angle that we were illegally terminated from my old plan and not given options to pick a new one nor given a benefits book for my new plan. What “winning” that case means for me, I have absolutely no clue, so we are planning for the worst (they permanently terminate my plan and any future plans for me) and hoping for the best (I get a free plan for life and automatic approval of any drug for life at a set copay).
I’m almost okay with the worst-case scenario, [Read more…]