When I am going to flip my SH&^!

I curse sometimes. In fact, I probably curse more than I should. However, it is usually for a justifiable reason. Today’s post for instance is probably going to be one of those reasons. If you have delicate eyes, you may want to put up some filters or just pretend you never saw this post appear in your news feed, email, or where ever you have seen this post linked to.

Last year around this time I had an issue with my insurance company and the provider of services for my DME supplies. The posts I am referring to can be found here and here. Usually when things occur, I like to protect the anonymity of the companies involved as I don’t want to leave people with a bad taste in their mouth for either an insurance provider or a DME supply company. The keywords being normally. This time not so much. I am at the end of my rope with Edgepark and their inability to handle me as a customer.

The back story is simple. November is rolling around and with that being the case I needed to reorder a new CGM transmitter as I was getting the warning of death that we have all seen. Nothing out of the ordinary. As the CGM warranty expired November 12th, I could not actually begin the process until November 12th. So, that morning I called and spoke to a very friendly reorder representative who was going to process my claim. (Now as with anytime I make a supply reorder, I explain to the representative that I need to have a pre-authorization from Blue Cross/Blue Shield of New Jersey for any DME claim over $500. I tell them, plus there is a note on my file.) The rep looks over my information, says he may need a new prescription or something from the Doctor’s office, but it should be fine. I ask him to add one box of sensors to the order as well, this way when December hits, I can do my 90 day supply and be set in this past benefit year. Not a problem. He calls me back later in the afternoon to tell me everything is fine and my out of pocket will be $XXX. Perfect, charge my credit card. I’m fine with that. In my head, I’m thinking, man this was too easy.

December rolls around and I get my first EOB on the claim from my insurance company. This service is not covered by my insurance company. WTF!!!!!!! I know it is covered, back in May/June when I was doing research on the current warranty of my insulin pump, I spoke with a very nice representative at Horizon and we verified benefits and made sure that all was in order. Which of course it was. So now I am a little pissed off.

A few days later, I get a phone call from a representative from Edgepark to say that my claim has been denied by the insurance company both the one from November and the one from an order made in June because the order is being shipped to an address not on my account. No shit, you can’t send packages via UPS or Fedex to a PO Box. So he asked that I call my insurance company to sort out the address discrepancy. Once again, I make a phone to Blue Cross or Horizon, or whatever name I use for the insurance company. The person who I speak to on this call, is once again nothing but the nicest/friendliest if not confused person in the world. The insurance representative looked at the claims and the reason for denial and said that in no way was the problem associated with an address issue. He further went and made a call to Edgepark to speak with billing to get me more information.

Basically after about an hour on the phone with this individual it was confirmed there was an error on the end of Edgepark and their billing office was working on it. Mid-December I get a new EOB from Horizon, guess what, the problem is still there. Now I am pissed to no end. I know it is not the fault of my insurance company, but I still make a call to verify benefits. The representative who I speak to this time is even nicer than the last guy. We look at the DME coverage of benefits and everything is fine, once again she makes me aware of the fact that anything over $500 needs to be pre-authorized. So, we start the game again Eileen gives Edgepark a call once again to see what the issue is. She ends up speaking with someone in billing, who admits, “we messed up.” The person who originally submitted the claim got in house authorization, but never got the authorization from Horizon. Edgepark, was not billing me just yet, but was now in the process of getting the authorizations for a service provided. Ok, great, will this work? I still have no fucking clue.

Now we are coming to the end of the benefit year and I have two options, see if Edgepark has gotten their shit together or go elsewhere. In my earlier in the month conversation with my insurance company I was informed that Dexcom was listed as an in-network provider and I could go directly through them for CGM supplies. So while all of this mess is going on, I contact Dexcom to see how things stand with their relationship with my insurance, their rep Brian, was able to verify that they could get my supplies for me and it would cost about $185 for a 3-month supply. I questioned why it was so much more than Edgepark, where I was supposed to be able to get a 3-month supply for around $90. His guess made sense. So he was going to do more research for me, but also see if there was another 3rd party vendor that is not Edgepark that I can deal with that might be able to give me comparable rates. Mind you, the extra $80 is not going to break the bank, but if I don’t have to pay it. I am not going to pay that money.

After speaking with Dexcom I decided to give Edgepark one last chance to not screw me over. I call in a reorder for sensor supplies on the 22nd, which is more than enough time for the supply reorder. The person who I speak with looks over my account, sees TWO notes on file in regards to authorizations necessary and says, to not worry they have plenty of time to get the order processed. Skeptic that I am, I call to verify the status of my order on the 30th. They are having issues because of the other bills in their system and will try to push the order through before the New Year. 4:00 New Year’s Eve, I get an email that states they are just STARTING to work on my order and need to get the approvals, which could take 5-7 business days. ARE YOU F-ING kidding me?

I have done my job, I have done my due diligence, why the hell can’t you get your shit together and do what is right? This situation should never have even started, because my file has all the proper information in it, in regards to what needs to be done. More so, I cannot be the only person who has BC/BS of NJ that uses a CGM. Edgepark is the provider that is designated to work with our insurance company. How is there this much confusion? I am so very frustrated, in fact I am fucking fustrared. That’s how annoyed I am. Not only have they screwed me in November, still waiting on that resolution, now they are screwing me again in December/January. If this ever gets sorted out, I am sure this will be a “new” benefit year even though Edgepark has been sitting on this order since the 22nd. That means my out of pocket and deductible have been reset. I can’t remember what that is, ballpark $250/$350 plus the co-pay I will now need to pay. Which will most likely be $100.

We trust these companies to do right by us. We are expecting them to do the right thing. However, they are idiots more often than not, and we are the ones who suffer. Once all of this settles down, hopefully in my favor, which I doubt. I will be calling Dexcom and seeing what Brian was able to figure out for me. I will also be notifying those are both my insurance company and also Edgepark of the incompetence I have run into. Following that, I will be doing everything within my power to ensure that I never have to interact with Edgepark again, unless I have no other options. I will absorb the xtra cost associated with dealing with Dexcom if necessary, to just be able to avoid this crap in the future.

On a happier note, it’s a New Year and well puppies!!!!