I work for a dr's office. Last week, we were told by the patient's pharmacy that insurance required a prior authorization through CVS Caremark before approving the medication. They faxed us the questionnaire that CVS Caremark required for approval. It was given to the dr to complete, sign and fax back. This was faxed back on Friday afternoon. Monday morning, I received a call from the patient's mom stating that the pharmacy claims that insurance denied it again.
I called CVS Caremark and spoke with someone who stated that they have the questionnaire but now needed a letter of medical necessity. When I asked why, and why no one let us know, the response was, "I don't know." They also told me that we faxed the questionnaire back to the wrong number (the number which was ON the questionnaire for faxing back). I was given a different number.
The dr completed the letter of medical necessity about an hour later and we faxed it to CVS Caremark, using the number given to me.
Mom called again this morning, stating that insurance was still denying the medication. I just got off the phone with a girl who told me that it's been sent to appeals, and that turn around time is 15 days. I asked if they had the letter we faxed, as I couldn't understand how this was going to appeals when the dr provided reason for the medication. She didn't seem to know where it was, and then told me that the fax number given to me yesterday was for BC/BS insurance, so they don't know if BC/BS got the letter or not. I then asked who it was being appealed by and she said BC/BS. I asked why NONE of this was explained to me yesterday, and why she wouldn't explain to me until I asked specifically. Her response?"I don't know." She also didn't know the number I needed to call to at BC/BS.
I hate having to deal with this company - this is just the latest bout of bull we've had to go through.
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