Changing health insurance and/or pharmacy benefit manager can be easy, or it can be a tangled web of countless hours trying to get the right information. Rarely is it anything in between.
Having recently gone through this after being laid off from a job I've had for a while (if you know anyone who is hiring, let me know), I'll share with you how I managed to keep my wits about me, despite many hours of phone calls and wrong information at almost each step along the way.
Know what you need:
I may not know where my keys are half the time, and my desk is always a mess, but I am quite methodical when it comes to many things, especially getting what I need to manage my diabetes.
I recommend starting by compiling a list of all of the medications and other related durable medical items you need.
The pharmacy list should contain doses and quantity of medication needed.
The durable medical (insulin pump supplies, CGM,etc) should include the manufacturer item number if you have it, this can help eliminate wrong orders.
Not only know what you need, know how soon you need it so you can escalate if need be.
Expect the unexpected:
This advice often drives me nuts, but it's true. The things I thought would be an issue like CGM coverage weren't. The things I thought would be a non-issue, like approval for my strips with a prior authorization, have turned out to be a major pain in the neck.
Micromange!
Follow up, keep an eye on progress if you can through pharmacy websites. Check on everything, and inquire as you need.
I learned today that despite asking my doctor's office 3x in email for Humalog insulin, they submitted the prescription for Novolog. I can use either, but this insurance's preferred insulin is Humalog.
I also learned today that a prior authorization for my strips was submitted, but denied. They told me that it would be approved if the meter I use is the only one my insulin pump communicates with, which is my situation. I have no idea now what was submitted in the PA, but now that has to be followed up on.
Take notes:
I sometimes have trouble with this, and if you end up making a lot of calls and getting lots of information, most of which is wrong, it's helpful to try and plot it out. Who said what and when can be helpful, especially if you have to escalate.
Insulin pump supply saga...
I started the process by calling Cigna to find out what they cover, and how to obtain my insulin pump supplies and CGM. I was happy to learn that it was all covered. They said to call CareCentrix to order my durable medical. Simple, right? Ah, no. If only.
I called CareCentrix to start the process, but they instructed me to ask my doctor for a prescription for what I needed. I questioned this as usually the third party submits the order, dr. fills it in and off it goes. I called 2x to confirm this and each time received the same terse answer.
I called the doctor's office and explained what was needed, and they never heard this so they kindly offered to call CareCentrix.
My doctor's office called back a few minutes later and said that CareCentrix told them that I should call Apria or McKesson, 3rd party distributors. The doctor's office suggested I called Apira as said they currently work with them, and not McKesson.
I called Apira, and to no surprise, said they are not contracted to work with Cigna and they can't help.
I called CareCentrix again, and pleaded to the woman on the phone to help me. I explained the situation, and pleaded with her to help me out. With a few short keyboard strokes she told me that Medtronic is a preferred vendor and to call them. She explained that CareCentirx is sort of a clearing house for the insurance company, they just confirm benefits.
I called Medtronic and within a few minutes I was set. The person on the phone told me they have a dedicated team that works with Cinga, and I was set.
I call my doctor's office back a few days later to make sure they got what they needed from Medtronic, and to no surprise nothing was sent.
Another call placed to Medtronic, and it turns out there was a valid prescription for what I needed. I asked the person to double check, as that's not what I was told on my prior call.
A few days later I received a call from Medtronic, and received an email that my pump supplies are on the way but my CGM sensors would be a few weeks. I have to look into that again this coming week. Despite being the queen of follow up, there's only so much even I can take. Long story short - micromanage,take notes, micromanage, and be sure you get what you need when you need it. In these situations don't be afraid of being assertive and escalating!
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