I went to my gynecologist for her annual spelunking appointment and she wrote me a new prescription today to help with (men, you can come back in a paragraph if you want) my hormone-induced perimenopausal symptoms such as hot flashes, bloating which mimics the USS Dallas (as seen in “Hunt for the Red October”) spontaneous melodrama, night sweats, in-the-basement reason forgetfulness, brain fog, insomnia, inability to make sandwiches, and laundry neglect (that last one’s a gimme).
The medication is relatively new, so I’m relatively freaked out about it. There isn’t too much data on it. It’s a super low-dosage cousin of some rather storied and potent shit out there, so I’m not sure I’m dedicated to the cause yet. I mean, what’s (sorry men, I lied, come back in another paragraph) wrong with some really heavy cramps, ennui, intense bleeding, possible anemia (isn’t the harpie look in this year?), totally inconsistent period arrival and the occasional urge for solace by digging a hole to China under a crescent moon with my bite guard?
Other than Flonase and antibiotics for the occasional lapse of taking my Flonase, I don’t take
many prescriptions. I like to go the herbal route. The supplement route. The what-the-fuck-is-in-this?, but-at-least-it’s-not-linked-to-inducing-suicidal-thoughts route. It might not always be efficacious, but I also believe in the placebo effect.
So today, because of this new script, I called my insurance company to learn the ropes about costs and copays and deductibles. Before I got too deep into the details, my very helpful Aetna rep told me I needed to call CVS / CareMark whose wizards would know the answers to all my prescription-based questions.
This is how that call went…
CareMark: Thank you for calling CareMark, may I have the member ID?
Me: Hi, this is Molly Field. I’m calling to find out cost and copay details for a new prescription. The ID number is 1234567.
CareMark: Who do you work for? >slurp<
Me: Uh, myself. My kids. I don’t have a job that provides insurance. I’m a … yoga teacher…?
CareMark: Are you Daniel?
Me: No. I’m me. I’m his —
CareMark: Why are you calling about Daniel? Are you calling on his behalf?
Me: No. I’m calling on my behalf. My name —
CareMark: Why do I have Daniel’s information then? >clichslurk<
Me: You asked me for the account number.
CareMark: Who is this?
Me: I’m his wife. He’s my husband. I’m calling on my own behalf for me about … me.
CareMark: What is your name and date of birth?
Me: (relieved: now we are getting somewhere.) My name is Molly Field my date of birth is ___ ___ 1829.
CareMark: Ok. Why are you calling? >slurk<
Me: sigh. To get cost information on our policy and how much a new prescription will cost… When I dropped it —
CareMark: What is your account number?
Me: I just gave it to you and it seemed to confuse —
CareMark: Account number please. >skicch< I can’t look up anything without that… Do I have your consent…
Me: Yes. You have my consent. The account number will give you … it’s 1234567.
CareMark: Am I speaking to the spouse?
Me: Yes. On my own behalf about medication prescribed for me.
CareMark: How may I assist you?
Me: Ok. I’d like to know cost and copay information about a medication called STOPSHITTYSYMPTOMS.
CareMark: That’s the 7.5mg dosage, correct? >skicch.<
Me: (after memorizing the promotional crate it came home in, complete with two obscured magnets to keep it closed, what the what is this? a Michael Kors bag?? Now I know where the money is being spent by this pharma) Yes, 7.5.
CareMark: A 90-daysupplyis$97. Untilyoumeetyourdeductible. >skich.<
Me: What is the deductible?
CareMark: Thereareseveraldeductiblelevelsonyourplan. >slurp.< Oneis25anotheris35andthefamilyis65. Per year. >clitch<
Me: (what the fuck is that sound?) Ok. So what’s the copay?
CareMark: What are you talking about? What copay? >shlink<
Me: (irked and confused and super curious about what’s in her mouth) Ok. You just said … if I’m following you, why would I pay the full $97 for the 90-day supply seeing as how I’d met at least one of the deductibles you mentioned? I mean, even at the 65, I’d only need to pay, what… $32 and so then, what would the copay be after that?
CareMark: You >sklurk< wouldn’t have met the deductible.
Me: But you said the deductible was three levels. You said “25 and 35 and 65.” Those are the figures you gave me. So if I pay $97 for a 90-day supply, I would have already met the deductible. Yes?
CareMark: >slurp< No. Nowhere near the deductible.
Me: (slamming face with desk, wondering about the need for this medication when all I think we need to do is rid ourselves of idiots at call centers) But … that’s close to $400. A three-refill 90-day script, which is what I was given, will cost … $388, way beyond the deductible you quoted me. You just said, “25, 35 and 65 are the deductible levels…”
CareMark: (audible groan) >querlk< HUNDRED. TWENTY FIVE HUNDRED, THIRTY FIVE HUNDRED. SIXTY FIVE HUNDRED. (you freaking idiot.) That’s your deDUCTible levels.
Me: (oh hell NO you didn’t…) HUNDRED?! As in Twenty-five hundred dollars for a deductible? Is THAT what you meant? (CareMark Mistress of the Dark is >sklerking< in the background…)
You said “twenty-five, thirty-five and sixty-five” and didn’t say “hundred” after any of those figures. So naturally, I thought you were talking about an entirely different denomination… >pausing to listen< Um, (with obvious bitter disgust) are you eating something? Because I can’t unders–
CareMark: >pause< No. I am not eating any — I am SUCKING on a COUGH DROP. I am SICK today. >SLERK SKECK CRUNCH<
Me: >pause.< Oh. I ask if you’re eating something because I’m having a hard time understanding you. You aren’t speaking clearly. And, that you left out of that deductible information by a factor of one-hundred.
So, then, yes, doing the math that I understand now, I would not meet the deductible. That’s fine. It is what it is.
Now, since CareMark has been our prescription program provider for several years, can you tell me what my family’s history was last year on what we paid for prescriptions so I can get a sense of whether or not we even came close to meeting those deductibles? You know, so I can get a ballpark on —
CareMark Viper from Hell: You want a WHAT? >sklerk< From WHEN?
Me: (fuck you; you work for me) I’d like to know if you can provide me with a … report, yes, a report of what we paid last year for prescriptions so that I can understand how that shaped up… I know some systems won’t give access to data so maybe you need to transfer me (please o please o please transfer me…), but I’m just looking for a snapshot, if you will, of how much we paid —
CareMark succubus: I don’t know what YOU’RE talking >slurk< about, but I can give >sklech< a COST REPORT (you moron) of your prescriptions from last year. I can send it to you …
Me: (incredulous) Mmmmmm Nnnnnooooo. That won’t be necessary; you don’t need to print it out and mail it to me, I’m just looking for a quick-and-dirty here (still trying to be niccccce….) so that I can .. can you just look at it and tell me?
(envisioning bats pipping and fluttering about her head; her face slack, with green from the reflecting the screen) Is there a screen you can click on? Do you have that (carefully choosing my words) ca-pa-bil-i-ty on your sys-tem that will show you that his-tor-ic in-for-ma-tion so you can just tell me the cost report from reading it on your screen? (SMILING a TOOTHY GRIN but with narrowed eyes.)
CareMark demon: (likely hunched over one of those ancient monolithic IBM 8600 desktop computers we used to call “machines” back in the 90s) You didn’t meet it. >slerk< You didn’t reach your deductible last year.
Me: (oddly proud that we didn’t need that insurance but pissed we paid for coverage for it) Oh. Did we come close? I mean, would have this addition of this STOPSHITTYSYMPTOMS last year, hypothetically of course, would it achieved the deductible? (at this point, i’m not sure of why i’m asking about any of this; something about this woman made me want to pick at her though…)
CareMark: No. >sklerrrrk<
Me: Ok. Well, that’s that. (sincerely) Thank you. You’ve been very helpful.
She hung up on me. Not a “Thank you for calling CareMark and giving me a job to do and keeping my wages coming in…” or “Is there anything else I can do for you today?” or, I don’t know, “Good bye.”
I think she needs the medicine more than I do.
So then I called Aetna and told them what happened to me. They took a full report.
You’re allowed to be sick. You’re allowed to sklerk on a lozenge. But you’re not allowed to be viperous. You’re just not.
Here’s the final thing: I’m a big girl, I’m healthy, I’m happy and living a very wonderful and stable life. But I couldn’t shake the feeling that this puff adder would somehow meet up on that phone line with someone who’s really in need. Maybe a mother of an infant with a blood infection; a father who’s son is in rehab, y’know: PEOPLE. I was concerned that she would affect a person who’s rattled, whose spouse just had a stroke, or who needs to know about his or her new health plan and that this agent would treat that rattled spouse or parent or patient so horribly that the day would be ruined.
Truth be told, I thought of my father, who’s 84 now, and if he needed to call CareMark to ask about his prescription benefits. I thought about my mother-in-law, who’s 29, and considered her situation with that agent and I decided I couldn’t let it go.
So I called CareMark later on and spoke with management. The manager I spoke with was mortified by Elvira’s behavior and grateful that I called back.
CareMark redeemed itself to me on that second phone call. It turns out it’s not a “deductible,” it’s a Maximum Allowable Benefit (MAB), which is the exact opposite of a deductible. A deductible is threshold you must meet by paying into it, and it would eventually reduce your out-of-pocket expenses as you go forward. When you reach your deductible, your costs go down. The MAB is an already established account, with funds already in it, that when you buy your medication, that sum is deducted. When you run out of the MAB, you pay more. It’s like a bet the insurance is taking, that you will try to meet.
I don’t know how that rep has stayed employed.
Why am I in the basement and what am I looking for down here? Geez, I hope it’s not for the laundry.
We are in serious trouble. Honestly. I’ve had more convos like this with customer “service” reps than I care to admit. Sheesh. I hope it wasn’t too early to have a glass of red wine:).
My husband has Bipolar. Talking to insurance and pharmacies is a constant theme in our life. I could totally relate to this and I loved the way you told this story.
Thanks Meghan. As if the situations requiring the meds aren’t enough to deal with on their own…
There are so many square pegs who get “round-holed” into CSR work. My feeling is that recruiters and employers need to understand the critical relationship between hiring the right people for front-line jobs and the success of their business.