Friday, April 03, 2009

Two steps forward....


And that would be which humans, being resourceful in exactly what way?

I was quite aware that the trip down from my mountaintop customer service experience today was inevitable...but it felt so soon....and the descent, so far...

I know it's possible to order prescriptions online...have them sent to you...the whole internet thing and all....I've done it. And yet today, I knew, in the deepest recesses of my profoundly intuitive self that I would have to - for some cosmic reason as yet unknown to me - make a live visit to the Kaiser Pharmacy for my first transaction.

Entering the pharmacological SuperStore (Costco meets Epcot) was in itself awe-inspiring: a wing for Member Services (that came later), a cafeteria, health kiosks, a bakery (I'm sure they're serving a preventative form of sugar) all left my head spinning. When I managed to find my way to the pharmacy, I was confronted with Grand Central Station-like billboards advertising whose prescriptions were ready (felt a bit un-HIPAA-ish to me but perhaps data transmitted in open-air is less regulated).

In any case, all went somewhat as hoped - prescription received by doc, filled, waiting - until the Moment of Truth came: payment.

CONEXIS, the administrator (= money gatherer) of the COBRA insurance coverage on behalf of my former employer, had no issue taking my $800+ in cash I paid to continue coverage and updating its website to say I was now in "covered" status.

But they missed a little detail: they didn't tell my insurance provider. Which, I learned to my astonishment, was no vagary but actually standard 'practice': the customer service rep admitted that his whole raison d'etre is fielding calls from people trying to fill their first prescription or make their first doctor's visit (you know, get health services), only to get denied service because....

...patients are supposed to manually tell the provider that CONEXIS says we're covered and...

I'm clinging to the assumption that the ".org" means that CONEXIS makes absolutely NOTHING on these transactions.



I believe you.

2 comments:

Tony said...

Doesn't this mean that you cold just tell them you were with Connexis without actually having paid?

bisgeier said...

ah alas no....
the "workflow" is:
1-patient pays conexis
2-conexis takes cash
3-conexis tells the patient all is good
4-patient actually needs healthcare (Rx, doc visit, bus accident)
5-insurance company denies coverage
6-patient asks conexis to tell insurance company to provide coverage already paid for (oops)
7-conexis grudgingly does so
8-insurance company provides coverage

....it was #6 that I discovered yesterday....#8 won't happen w/o #6-7