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“Persistance pays off. Sometimes it’s even okay to be annoying because you will get what you want” – my dad

 

After 9 months…I will get my money back! If you are new to my blog, I will give a little review (you can read my experience in more detail here). I started sitting for the monthly Orencia IV infusion in September 2013. Since I already paid the deductible on my insurance, all my medications were covered. At the end of March 2014, I received a surprise 2-month delinquent bill for an invoice from January. It totalled more than 800 dollars and attached with a lovely note telling me they would stop my medication shipments. There are so many more issues with this but the one that really bugged me was my credit score. They were sending me the invoices, albeit to an address I have not lived at for TWO years, but because they thought I was ignoring them my credit score plummeted. I had fabulous credit before this. And, as you probably know, it takes patience and time to build good credit but only one missed payment to shatter it.

 

ANYWAYS…

I re-applied for co-payment assistance immediately. I contacted Accredo, gave them the new membership ID and asked them to backdate the invoices.

After more months of clerical mistakes, I still paid out of pocket so in July I started over.

I re-re-applied with Orencia IV Infusion co-payment assistance online, got a new membership card and after weeks, yes, weeks, found a manager at Accredo. There was a note on my account “if client calls again, tell them to call insurance provider”. I was so angry, I yelled at the supervisor. “This is not their issue, it’s Accredo’s for not applying the right information and sending the invoices to the WRONG co-payment assistance!” The manager “sat” with someone in the Billing department as they re-entered my new membership information and promised to re-send the invoices “to the right place”. Up until this point, they were sending them to Remicade co-payment assistance. (I HAVE NEVER BEEN ON REMICADE, if that gives you a sense of how INCOMPETENT this pharmacy is)

PS. I still do not know where they are sending those invoices but it is certainly not to Orencia.

 

I called Orencia to find out if they had received the invoices and they said no. However, Accredo had filed my benefits through the card on file and the May invoice was rejected. Why?

 

Because Orencia has a 45-day back-date policy.

 

I almost started crying on the phone to the Orencia rep. I was devastated and very annoyed. I wanted to file a complaint with the Maryland Insurance Administration. I was obviously not getting anywhere on my own and I needed legal help.

 

But something came to me, I asked her “I signed up for the new Assistance program in March through my doctor’s office. Where is that information?”

“It’s not showing that you were a member before July.”

“I was, I never received a card but I did recieve a membership number. Where is that information?”

Now, it’s important to know I talked with this specific representative at least three times since this ordeal began. She remembered talking to me in April “Wait a minute, let me go through your account…I would not have even talked to you in April if you were not a member”.

She went through my history with a fine-tooth comb and noticed a mistake in the notes. I had signed up with the IV copayment assistance program in March, with validation from my doctor’s office. For whatever reason, that membership information had not transferred to my account.

The representative contacted management and placed a request for exemption. It turned out it was a mistake on Orencia’s end so they accepted the exemption and agreed to reimburse me every single invoice from the beginning of the year, even though the January one was a little out of the 45-day bracket.

 

I kept repeating “thank you so much, if you hadn’t remembered talking to me before the May invoice, if you had not gone through my history the way you did, I would not be getting my money back.”

It’s amazing how just a little customer service goes a long way.

 

…But, there was a snag. (of course, right? It just cannot be that easy…)

Accredo did not send them any of the invoices, they could not do anything without those invoices.

I fished around through my bills from the last year and found every one of them.

…But, there was an even bigger snag.

 

They were not in my name. I am still under my father’s insurance so the invoices were sent in his. Also, the medication name was not even on them! They just showed the coverage adjustments.

The representative told me to fax them anyways. If they could not use them they would let me know.

Just in case, I called Express Scripts and asked them to re-send an itemized invoice in MY name.

 

I called a couple of times last week because Orencia was still processing the invoices and they had neither been rejected or accepted yet.

On Monday, I ended up speaking with this amazing representative again and she told me the checks had been sent out. I asked her the value of each check and I was so pleased to find out I am getting everything back. Well, everything minus $20, which is what I was only supposed to spend over the last 9 months. How much did I spend? Over $1,000.

 

I am not going to lie to you guys. I am exhausted. I was on the phone with Orencia, Accredo every week sometimes twice a week. The strain and stress of the situation put me right to sleep and I napped most of the day. I was close to my breaking point and I was ready to file a complaint.

But now, this is behind me. I re-start the Orencia IV again next week. These past two months have been pretty bad without it (which I will talk about in another post).

 

Persistance, my friends, does pay off. I’ve always been one to beat anything into the ground. My father usually says I am less persistent, more pig-headed than anything else…hey, if it works, right?

 

Hi, my name is Monica and I have RA.

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