It started as a routine reject. A quick phone call should straighten things out.
Me: Yeah I'm calling about this reject message I'm getting, It says that only Prevacid Solutabs are covered for patients over 1. I think the rest of the message must have got cut off or something.
Actually what I suspected was that Prevacid itself was non-formulary. Those of you in the profession know it is not unusual for an insurance reject message to bear little resemblance to the actual reason a claim is being rejected. A quick phone call and the nice lady would tell me which meds in the class were covered.
Medco: No sir, that is correct, only the solutabs are covered for any patient over 1 year old.
Me: Ok, that can't be right. Do you know what a solutab is? It melts in your mouth, which makes them, you know, ideal for children.
Me: Are you telling me if the patient is under 1 year old you would only cover the regular capsules?
Medco: The plan sponsor sets the parameters sir.
Me: That's not what I'm asking. If this customer was under 1 year old, I would have to give them the regular capsules. Is that how it works?
Me: And since this person is over 1 year old, a fully grown adult actually, the only thing I can give them is the melt in your mouth version.
Me: I can only give them the solutab?
Me: You realize.....that someone has obviously made a mistake here. A typo that should take like 2 seconds to correct.
Medco: It's the plan sponsor that sets the parameters sir.
Me: You understand that these parameters involve asking a 1 year old baby to swallow a capsule while making an adult take the formula ideal for children
Me: So you know this is stupid.
Medco: I understand your frustration, but I can't change the plan parameters sir.
Me: Ok, fine, but do you think that maybe you could contribute a little to the solution of this problem, like maybe telling your supervisor about this idiotic situation so they could perhaps open a line of communication to the people who set up the parameters?
Me: Can your kid swallow a capsule?
Medco: Is there anything else I can help you with?
Me: What exactly have you helped me with to this point?
Me: Is this call being recorded for training purposes? Because I think it really should be. Because this is....fu.....I stopped myself before the whole word came out because I knew that would be an automatic hang up and I wasn't done yet. I mocked the Medco lady. I ridiculed the Medco lady. I asked her if she was proud of the work she was doing. I was pretty Goddamn mean. I had to hand it to the Medco lady though. Cold. As. Ice. I was opening up on her with both barrels and there was no display of emotion, much less any budging. In the end, a 47 year old man got melt in your mouth Prevacid.
And somewhere a baby just probably choked to death. It's a good thing we don't let the government run health care though, because if the government ran health care, then stupid bureaucratic shit would happen.
Don't think the Canadians aren't laughing at us.