“Ain’t I a human?*” In my experience, certain insurers don’t think so; they have hearts of stone!
Just saying, when it comes to insurance coverage—at least coverage from a prominent insurance company based in Houston, Texas—staff has refused to approve my prescription for “brand” Synthroid pills–pills I have been taking (and been approved by said insurer for close to 35 years).
Hard to believe, but read on for a brief history of my insurer’s consistent denial of coverage, starting in November of 2021 and continuing to this very day–January 5, 2020.
Know that I am fortunate to live in Illinois—not Houston, Texas–where my allegedly considerate and supportive insurer is based.
In Illinois, responsible doctors and outstanding pharmacists don’t “get” why this Texas insurer won’t process my claim. To solve the immediate problem, outstanding CVS pharmacists “resist” this particular insurers blatant attempt to deprive me of necessary medication–these kind and competent professionals agree that the best way to get the pills is if CVS in Chicago sells (two times, that is) the damn pills to me. Not too costly–about $60.00. And given that a polar vortex is on the way, the pharmacists agree that I should buy at least 26 pills, cuz “baby, it’s gonna be could outside!!!”
How have I handled this flagrant abuse of responsibility by this prominent Houston, Texas insurer?
I did what most teachers and former litigatorsl do—yesterday, I asked the allegedly compassionate, yet unyielding insurance staffers just what the the “legitimate” process is… And this is not my first call about this prescription for brand Synthroid. I called the insurer last year, too.
You might be wondering how this prominent, Houston based insurer, tries to justify the denial of my historic—and consistent—need for brand Synthroid (medical reasons indicate the generic is worthless in my system). I want to be perfectly clear; the insurance staff is polite, but increasingly intransigent, as the dialogue below reflects:
“Sorry Mrs. Stern, yesterday’s staffer,” replies—our rules require that you file your claim anew–in this 2022 new year!
Yep–starting over in 2022 (after 90 days of denial) is the only institutional avenue for me to obtain “brand” Synthroid—even though the pharmacists have advised me that unlike most things folks are waiting for—there are no supply chain issues related to Synthroid; there’s plenty of pills.
Read below to see the unconscionable justifications staffers expect me to believe. In my heart of hears, I now fear this staffer is trying to appear to be concerned–but failing.
And put simply, I now–after months of being patient– am pretty certain that this unyielding and ever polite insurance staffer is required–by the Texas insurer– to have a “heart of stone.” Why am I listening to this mind-boggling and idiotic justification for this an unwarranted three month denial (and remember, as an insured, I am only entitled to a 90 day, pretty much equal to or even more than a three month supply). And the call gets even more and more disturbing:
We know your doctor has tried to verify that you need brand Synthroid, but Rhonda, your doctor continues to fail to follow through—now this tone-deaf, yet prominent, Houston/Texas insurance staffer has assured me that the giant, Texas insure is not heartless– even though she concedes that my doctor has tried to reach insurer more than a handful of times—it’s your doctors’ fault– and this inhumane staffer adds that we–the Texas insurer–does not have the manpower to correct this power; we care, but again, your only remedy is to
start over. WOW.
Bah humbug (my philosophy with jerks is to just demand that they get out of my way!!
Now I am starting to become very concerned and am deeply wondering why the heck I even pay premiums–when in the real world, my only “avenue” is to buy Synthroid from kind pharmacists at my local CVS.
I can’t help myself from thinking that just maybe—maybe–this prominent, stubborn, dehumanizing, Houston/Texas, company—does not aim to help most insureds, but aims to continue to put profit over human needs.
Now–in 2022– I firmly believe that we can all can do better. I worry that this insurer and its staff might not be able to do better, yet I still try to be optimistic and hope this company opts to change its policies–at least those related to issuing immediate denials. An educator can dream, but trust me, I don’t think the unconscionable behaviors of this highly profitable company are even remotely viewed as a “teachable moment.”
So– I try to keep the “faith” by turning to the wisdom of the late—and most renowned–educator, author, and Stanford professor, bel hooks (a/k/a Gloria Watkins). Professor bel hooks had a huge impact on me while I was doing the research required by my doctoral program; in fact my family, friends and students and their parents are aware that bel hooks, in her infinite wisdom and respect of others, continues to influence me!
hooks writes: my hope [bel’s hope] emerges..from individuals—[seeking to]…transform…the world around them. As teachers, we believe that learning is possible…that nothing can keep [even big, highly profitable, and genuinely irresponsible Texas insurance companies]..from..seeking knowledge and finding ways to know [even I am losing the faith that this crazy Texas insurer might support their insured–those trusting folks who pay some hefty premiums–and don’t really realize that they might–in my humble opinion–get screwed).
Once again, I am seriously wondering if insurers–and fakers that work for them– are human? And if they can act for the common good?
You, readers, can be the judge of the “character” of staffers (and intentions) at this prominent, Texas insurance company. And for guidance on following the rule of law—not the irreverent and audacious and illegal practices that govern Texas and its corporate entities, my inner litigator self gains hope–and pride–after listening to Attorney General, Merrick Garland’s, profound speech that ended minutes ago.
MERRICK GARLAND is a HUMAN and refuses to accept fraud, neglect, conspiratorial tactics—or anything else– that violates the Constitution. Betcha that commitment applies to other writings—like the disingenuous and fraudulent and dehumanizing policies–crafted by audacious Texas based companies–companies that deprive citizens of insurance coverage paid for, but not delivered; yep, by insurers with hearts of stone.
Attorney General Garland prioritized–Constitution first–and then we will pursue other criminals next!
Gotta tell ya, in my experience, I’d advise those illegal Texas and crafty insurers—better revise or “better watch out.” Or, there will be consequences–yep, crafty, dehumanizing insurance jerks– need to be worried because those who govern will follow the facts and punish any any and all criminals.
And in teacher talk, listen up, or the principal will make you face the consequences. Surprisingly, this comes from an educator who never has sent a kid to the principal, but did pursue–and issue consequences–with respect to a few grad school demons who failed to follow “the rule of law.”
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