| BCBS Says Triptan Limit Was an Error | |
BCBS notified Ms. Brown that there is no limitation on triptans in her policy, said they "made a mistake."
Continued from BCBS Still Limiting, Declined Response
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Recap of Situation and Events:
- Blue Cross Blue Shield of Florida (BCBS) has been having Miss Brown's pharmacy change the prescription written by her attending physician so that less Maxalt is dispensed than her physician prescribed.
- When Miss Brown found BCBS to be unresponsive, she asked me to represent her as her patient advocate.
- BCBS representative Chris Luke presented me supposed reasons for the limitations, which I was able to prove to be false. Then he quoted a limitations clause that was supposedly in Ms. Brown's policy. When I told him I couldn't find it, and asked him to tell me on what page of her policy it could be found, he said he'd call me back, but didn't do so, and whenever I tried to call him, he wasn't in.
- On January 28, when the first article of this series appeared, Mr. Luke called me, asking where to find the article and to say that a staff pharmacist would be calling me to discuss the case. I have heard nothing from anyone at BCBS since then.
- In the interest of balanced and fair reporting, I repeatedly invited Blue Cross Blue Shield to offer comments or make a statement. They never responded.
Since Our Last Article:
- Ms. Brown followed the BCBS appeals/grievance procedure through phase one, and was still denied access to the amount of Maxalt® she needs.
- A formal grievance hearing , the second and last appeals/grievance step outlined in her policy, was scheduled for Friday, February 28, 2003.
- On Wednesday, February, 26, the
supervisor of the BCBS's grievance department contacted Ms. Brown, saying he had
"good news." Ms. Brown told me,
"He said that they had further reviewed my policy and all the information I provided and that the limitation was a mistake. I was in complete shock. He went on to explain to me that this really was not an adversarial process (I had told him earlier in the week that I was bringing a court reporter and that I did consider it an adversarial process and considered BCBS "the enemy", and he actually thanked me for bringing this matter to his attention!!! Then, he said that there are no limitations on the Maxalt my doctor prescribes. He was then ready to get off the phone and I said "does this mean that I am also reimbursed for all the money I laid out?" HA! I also asked him to put it in writing and send this information to me. I am providing them with copies of my receipts and they are reimbursing me. He also said that the type of policy I have has a state mandate that nothing can be changed."
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