Future Scripts (https://www.futurescripts.com/FutureScripts/) is another pharmacy benefits management company that services Personal Choice and Keystone Health Plan, Independence Blue Cross products. In general, pharmacy benefits management companies serve one purpose – to manage your prescriptions. They typically consist of a mail order branch, which, for Future Scripts, is now Catamaran when it also used to be called Future Scripts, and the “management” branch, which mostly refers to the prior authorization department. Or, put differently, we can call that the treatment denial department. Prior authorizations are becoming increasingly stringent and what is allowed far more restricted. It seems that these companies utilize a number of different strategies. One is to inform patients that “we contacted your doctor and have not heard anything back.” This is often the furthest from the truth but is, I believe, part of the overall script of denial and delay. The longer something is not paid for, the longer the money sits in the coffers of the insurance company. Their latest wrinkle in delaying care was a bit more insidious than the usual denial.

Last week I prescribed a newer antidepressant for a patient. Previously she had been receiving samples but I had run out. She just got insurance and the luck of the draw gave us Future Scripts as the manager. I submitted the prior authorization request without prompting, knowing it would be required. I used their general prior authorization form. I received a call back asking if I was also requesting a tiering exception (which would lower my patient’s copay). There was no option for that on the existing form so I called the number (I dread calling because it is always a waste of my time on the phone). It rang – I counted – 40 times, no answer. Thinking perhaps I had used the wrong number I called again, same result. The third call I placed a pushed an option to speak to an agent and was routed to Catamaran, the mail order pharmacy, and they of course knew nothing about this case nor could they even locate my patient in “the system” using her name, date of birth and insurance ID number! Frustrated beyond belief, I created my own tiering exception form from one of their existing forms and faxed that in before leaving the office. The next day, the same woman who had left me the message about the tiering exception called again. This time when I called back she answered and I vented my frustration. She only added to it by telling me a different technician must have received the second form. She admitted they have NO VOICE MAIL for their extensions, which is why it rang 40 times twice. She also told me that the form I had initially submitted that she saw was actually the correct form for tiering exceptions too but it had no place to ask for that! Frustration comingled with bewilderment at this array of alarming information. After venting some more I informed her that if the medication was not approved WITH a tiering exception by the end of the business day I would file a grievance with the state insurance commission. Magically, both the medication itself and the tiering exception were approved, though of course not before wasting two separate fax transmissions to me to inform me of this. MY patient’s care was delayed nearly a week as a result of this.

And just this week, another company added their special brand of planned incompetence. Aetna (https://www.aetna.com/individuals-families/members-pharmacy-prescription-benefits.html) requested a prior authorization for a patient’s generic Concerta (methylphenidate ER, an ADHD medication). I submitted a request on an Aetna form, but received a phone call informing me an attempt to fax me had failed. I checked the fax log first and it hadn’t failed. My sense of foreboding began to rise. I filled out the newly faxed authorization form and one of the questions I had to answer was the following:

Does the patient have documentation fo symptoms significantly impacting, impairing, or compromising the patient’s ability to function normally (ie., attend/maintain academic enrollment or employment)?

The answer I gave was yes. It was clearly noted, as the box for yes was filled in while the box for no was left blank. I received a faxed back reply with the following reason given for a treatment denial:

The information did not show that you have symptoms significantly impacting, impairing or compromising your ability to function normally as listed below.

There was no list of symptoms below that. I faxed back with a letter explaining that I had already answered yes to that question and demanding a reason for the denial. Again, I was forced to call to speak with a pharmacist, as the technicians who call are not permitted to render decisions but simply gather information from me while reading from some scripted algorithm before handing me off to the pharmacist, who asks all the same questions. Again, a threat of the state insurance commission along with a threat of legal action this time produced a swift reversal of the decision, but no explanation for the denial after the one question on which the denial had been based had actually been answered affirmatively.

If you are a patient reading this, you may have had similar experiences. Hopefully your doctor will go to bat for you or has office staff to do that. If not, you do have recourse by filing a grievance with your state’s insurance commission and by trying to find a law firm that specializes in managed care, or mangled care, as I like to call it.

National Association of Insurance Commissioners: http://www.naic.org/state_web_map.htm

No Silver Lining – the Cost of Medicare Part D Prescription Drug Plans

When Medicare Part D (Medicare prescription drug benefit) was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006, it was haled as blessing to our seniors and anyone else covered under Medicare. The plan was for the federal-government to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. I have written elsewhere about this program’s actual effects on its beneficiaries (http://www.physicianspractice.com/articles/underdog-doc-takes-payers-patient), but it is important to write again now as the landscape is changing. Of course, the Medicare Part D program was an incredible business initiative for health insurance companies to jump in and begin wielding there ever sharp carving knives. In Pennsylvania, where I practice, I counted 15 companies, including one partnered with Walmart. Nothing like competition for a slice of the dollar to create an environment focused solely on that very dollar. One of the ways they have consistently been able to keep their daily balance ledgers in a comfortable place to keep their stockholders happy is by becoming every more stringent with prior authorization requirements. On average I work about 10 extra hours a week, all unreimbursed, to make sure patients get their needs met. I realize this poses an extra burden on doctor’s offices, but continuity and quality of care are at risk.

Recently, I was asked to complete the omnipresent prior authorization request for an elderly man’s sleep medication. His Medicare PDP (prescription drug plan) insisted that the sleep medication he had been taking would only be permitted for 90 nights a year. 90 nights a year! So for the other 275 nights of the year his insomnia was supposed to disappear, magically, so Silver Script, the company involved, could save money. He had been taking it for years before ever seeing me and attempts to take him off of it lead to sleepless nights. When he doesn’t sleep for long enough he becomes severely anxious and that can set off his cardiac arrythmia. Weighing the risks and benefits, I decided to make sure the medication was approved. I faxed the requisite form and with the strong wording I usually use, I expected a response from Silver Script within a 24 hour period. Instead, I got another form and a phone call as well asking the same exact questions I had already answered. On the form it asked if I had tried other “non-high risk medications” (I had already provided that information in my fax). My frustration turned to a complete sense of incredulity upon reading their list of non-high risk medications: temazepam and doxepin. Temazepam is a benzodiazepine medication, in the same family of medications as Xanax, Klonopin and Valium and far more “high risk,” particularly in older individuals, then the medication I had requested. Doxepin is an old tricyclic antidepressant that is rarely used for depression but is often used in very low doses for sleep. Tricyclics can cause cardiac arrhythmias and therefore are not necessarily non-high risk medications either. To add to my growing state of alarm is the fact that the form came AFTER there had already been a phone conversation, during which I demanded to know why my original form had been completely ignored. The “pharmacy tech” on the other end kept apologizing and telling me she knew how frustrating this must be, though I wondered if she was sitting with an algorithm sheet of what to say to irate doctors in the same manner they have algorithms to ask questions about the prior authorization request in the first place.

Prior authorization requests are becoming increasingly common not only for more costly brand medications, but for quantities of medications allowed per month. That’s right – quantities are not also being more tightly regulated. It doesn’t matter if you’ve been taking a certain amount for a long time. Your doctor will become ever more likely asked to complete a prior authorization request to make sure your treatment can continue uninterrupted. What can you do to advocate for yourself?

1. Know your benefits well, and if you are having trouble deciphering all the insurance company speak, find someone who can help you understand it.
2. Don’t take no for an answer. That means don’t immediately accept a change in a medication that may have stabilized you in favor of some less costly generic medication (see my earlier post about generic medications and the possibility that they may be inferior http://www.danielblockpsychiatry.com/). In addition to the prior authorization your doctor or his/her designated administrator can demand a lower copay tier under your Medicare PDP. I have done it several times for patients.
3. If your receive a negative outcome, there are appeals and grievance proceedings, but let’s face it. The 5-10 page document the insurer sends outlining the appeal process is cumbersome and full of dense language. Your doctor can cut through some of this bureaucratic mess by demanding to speak with a supervisor, but both you and your doctor can place a complaint with your state’s insurance commission. The link here is to an interactive map for the insurance departments of all 50 states: http://www.naic.org/state_web_map.htm
4. Write to your State Representative and State Senator with your grievances. Remember, they depend on your vote to get into office. Let’s remind them they need to listen to their constituency if they hope to get re-elected.
5. If you have access to the media, see if you can be interviewed by a local newspaper or radio/television program. Also, if you or someone you know is tech savvy, start a website or blog for complaints about insurers. This can be easily done using Facebook (www.facebook.com)

I am hoping that this post will help people on Medicare Part D plans or their families to maintain a sense of participation in their own care while understanding better the current climate in health care.

I have written a number of times about the various practices that insurance companies employ that keep people from getting their needs fully met. Specifically, I have focused on the prior authorization process. So what can happen when it initially seems to go well? I can submit a prior authorization request and have the request approved and all seems good, right? I received a distressed phone call from a patient of mine for whom I had gotten approval for the brand name version of Wellbutrin XL (bupropion extended release), a highly effective antidepressant that does not cause sedation, weight gain or sexual side effects. Unfortunately, her insurance company failed to mention that it would be approved but at the highest level of pay. This is known as the copay tier system, one in which there are preferred generics, non-preferred generics, preferred brand names and non-preferred brand names. I have yet to be able to get an explanation from anyone at any insurance company as to how these tiers are determined, which leaves me to speculate, though I believe my guesswork is most likely quite accurate. Medications are chosen for the various tiers based on the cost to the insurer. So the patient’s Wellbutrin XL 300 mg tablets were “covered,” but at roughly $600/month! The generic would have been a “normal” copay, which would be anywhere between $10-$30/month, which is much more palatable. This patient requested a prescription for the generic with the knowledge that it might not be as effective. The trouble with this particular generic, which was made by Teva, began when an independent consumer lab tested it and found that it was releasing about a third of its contents in the first 2 hours, as opposed to the normal 8% of the brand name. About 5 years later the FDA finally decided to pay attention and mandated that generic makers of the 300 mg dose, the dose in question in this case, pull their products and re-evaluate them. Teva’s product was not permitted back on the market and was therefore withdrawn. The same product made by Impax was also withdrawn. Furthermore, the FDA did not test the generics from four other makers – Anchen, Actavis, Watson, and Mylan. That was well after there were also lawsuits (to learn more, http://www.medhelp.org/posts/Depression/Problems-with-Budeprion-XL-generic-Wellbutrin/show/1012337). It seems that when the FDA originally approved the 300 mg generic, it based that decision on the efficacy of the 150 mg dose, never really requiring testing of the 300 mg dose (to learn more, http://www.drugstorenews.com/article/fda-issues-new-guidelines-budeprion-xl-300-mg-strength). A drug rated by the FDA as AA is the exact equivalent, meaning there are no known or suspected bioequivalence problems, or if there were, they were resolved in satisfactory fashion. An AB rating includes products that meet necessary bioequivalence requirements. Please see my previous blog about the 80-125% rule to better understand this category and therefore waht AB truly means. My patient is presently relegated to an AB rated product that has a history of bioequivalence problems, with two previous generics having been removed from the market in the 300 mg form. There are three brand name versions of bupropion XL: Wellbutrin XL (http://www.drugs.com/cdi/wellbutrin-xl-extended-release-tablets.html), Aplenzin (which is actually bupropion hydrobromide, not hydrochloride, though that difference does not have clinical ramfications) (http://www.drugs.com/aplenzin.html), and Forfivo XL (http://www.drugs.com/price-guide/forfivo-xl), a niche product focusing solely on the top dose, 450 mg. To learn more about the FDA’s AA vs AB rating system, please see http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm#Therapeutic%

20Equivalence%20Evaluations%20Codes. For now, I can only hope I can manage to procure more brand name samples of either Wellbutrin XL or Aplenzin to supply to my patient. If you are having issues with this particular drug and in a generic version that seems not to be working, talk with your doctor about the brand name. But first, learn your insurance company’s copay tier system, because the prior authorization may mean nothing once you see the sticker price of a month supply.

GENERICS do not equal BRAND: The 80-125 Rule

Your insurance health plan’s prescription benefits clearly state that when and where a generic is available, you have to try a generic or incur a higher cost, either meaning a higher copayment of no coverage at all (that means you pay out of pocket for the full retail price of the drug). In so many cases, generics are allowed. And why shouldn’t they be? After all, they’re FDA-approved, right? And it’s common knowledge that generics are the same as, as good as, the brand name. And doesn’t everybody knows that brand names cost a lot of money because the evil Big Pharma is out to make a profit? So why not generics?

In many instances, generics do actually perform just as well as the brand name without any increase in side effects or drop off in therapeutic effect. Take Prozac, for instance. It became widely available in the US somewhere around 1990 (it was FDA-approved in 1987). Its patent expired in 2001, and generics were soon available. In my practice, I have had many patients taking the generic without any problems. I had no problem prescribing it because I have always been cost-sensitive and don’t want my patients having to pay more than they have to to be able to afford quality care. But I also remembered being taught in psychiatric residency training that the FDA actually permits a generic drug to be determined “bioequivalent” if its contents are 80-125% of the targeted dose. That means that a 100 mg dose of Brand X could essentially be anywhere from 80-125 mg of generic X and still be considered “bioequivalent.” To learn more: http://www.consumer-health.com/services/5CommonQuestionsAboutGenericDrugs.php

Several years ago, a patient with bipolar disorder called me complaining of all the symptoms of depression except this patient was not depressed. Symptoms included weight gain, sluggishness, fatigue, increased sleep, decreased energy and concentration, poor motivation and loss of drive to do the things normally of interest to this person. I immediately ordered a lithium level and it returned in the toxic range. It was nothing that stopping the drug for 24 hours couldn’t correct, but it concerned me because her dose had not changed and had the level been a few tenths of a point higher, we would have been looking at a hospitalization. I asked my patient about any medication changes, new medications or any other new medical conditions. The answer to each question was “No.” I asked if the color or shape of the pills had changed and the answer was yes. It turned out that the brand name lithium this patient had been taking had been switched over to a generic. That was the only change. The 80-125 rule was in effect.

Not long after that, patients of mine began complaining whenever their Wellbutrin XL 300 mg was changed to the cheaper generic, Budeprion XL 300 mg, manufactured by Impax Laboratories, Inc and marketed by Teva Pharmaceuticals. In 2008, an independent consumer lab was able to demonstrate through testing that the generic version was dumping roughly 34% of its contents into the blood stream within the first two hours of ingestion, whereas the brand name drug released 8% in the same time frame. Patients were complaining of increased side effects and a recurrence of depressive symptoms. It wasn’t until March 2013 that the FDA formally withdrew the drug from the US market as an approved generic, though it had asked Teva to stop distributing it in September 2012. Contrary to the FDA’s study in 2007 that concluded the two were bioequivalent, the 2012 review concluded that “Budeprion XL 300 mg fails to demonstrate therapeutic equivalence to Wellbutrin XL 300 mg.” Watson Pharmaceuticals, which purchased Actavis (a company that was months behind in submitting tests bioequivalency tests to the FDA for its version of generic bupropion XL), agreed to voluntarily pull that product from the market in October 2013. To learn more: http://www.raps.org/focus-online/news/news-article-view/article/4184/second-generic-version-of-popular-antidepressant-to-be-pulled-from-market-for-b.aspx.
Further information can be found at http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformation
forpatientsandproviders/ucm322161.htm

And in July 2014, the FDA announced that over 40,000 bottles of generic venlafaxine ER (generic for the antidepressant Effexor XR) had been voluntarily recalled by Sun Pharmaceutical Industries, an Indian drug company, for failure to meet “drug dissolution specification.” Drug dissolution is a way to understand how a drug behaves in the body. The FDA classified this as a Class II recall, which means that using the product could cause temporary or reversible negative consequences. To learn more:
http://www.accessdata.fda.gov/scripts/enforcement/enforce_rpt-Product-Tabs.cfm
action=select&recall_number=D-1415-2014&w=07092014&lang=eng

It is vitally important for patients to be aware that generics are NOT necessarily equal to the brand name medication. A return of symptoms is not necessarily a call for more medication or a change in medication. In my practice, I have been telling patients to inform me of any change in color, shape, pill type or other changes whenever they receive each new prescription. Typically, health plans will purchase the cheapest generic available, so this is especially important with your mail order prescriptions. Doctors who may be reading this should adopt a similar practice of educating patients about eh 80-125 rule if not already doing so and encourage patients to adopt a similar reporting practice each time there is a prescription renewal. Additionally, with a little effort (ok, sometimes a lot), doctors can get the brand name approved AND a cost exception to the copay tier with the submission of the proper documentation to the insurance company. It may mean threatening filing a grievance with the state’s insurance commissioner and/or legal action to get the job done, but as physicians we need to advocate strongly. Also, in cases where there is no insurance, patients may be eligible for patient assistance from the drug manufacturer, which means they can receive free supplies of the brand name. I have a number of patients who are benefiting from these charitable services.

So, here is another great example of why I get so fired up about insurance plans and the prior authorization process. For privacy reasons in this case, I will not reveal the name of the health plan. Below (redacted to preserve identity) is what I sent explaining my choice of Rozerem, a non-addictive sleep drug. Despite what I wrote, I was told that temazepam or zolpidem had to be tried first.

Insomnia has been an issue with patient A. Patient A cannot take benzodiazepines (temazepam, estazolam) for sleep because of a history of addiction. If there is random drug screen at work that class of medications will produce a positive urine. Zolpidem (IR, CR), zaleplon and eszopiclone may also pose abuse risks. Also, zaleplon is NOT indicated for chronic, persistent insomnia and is only used for initial insomnia or middle insomnia anyway. Patient A tried trazodone but was far too sedated the next day, even on a very low dose. If his Patient A’s insomnia is not treated, Patient A cannot function the next day at work and also notes worsening depression. Rozerem is one of only two sleep drugs that are FDA appoved for long term management of insomnia (eszopiclone (Lunesta) being the other) and it has no dependency potential.

How much clearer could I have been? The medical director with whom I spoke assured me that “the forms get scanned into the computer and sometimes we don’t get all the information sent over.” It should be noted that there was only one form with one page of actual patient and clinical information. I was told that the medical director who reviewed, therefore, must not have “gotten that page,” but when I asked him to look at what they had received, he began reading from the same page that I had sent. When I directed him to the box for written explanations, he then saw the above paragraph. He had no explanation why it had either been ignored, perhaps not read at all, or deemed not important enough not to deny the Rozerem. Multiple times, he assured me that he will “have to look into this.” How empty that sounded. This was not the first time with this health plan that I had the same issue with the same. Of course, after speaking with me (which took three separate calls), the Rozerem was approved.

If you are a physician reading this, please know that though this is very time consuming and causes a lot of aggravation, our patients are not at fault nor responsible for their insurance plans. And we shouldn’t have to go through such as arduous process each time we want to prescribe a medication. If you are a patient or someone who has been on the other end of one of these decisions, know that with some diligence and persistence on the part of your doctor of the doctor’s staff, you can get the medication he or she prescribed originally. It should never be that the insurance company should be making decisions about your care.

As an update to my previous blog, IBX (http://www.ibx.com/index.jsp) as of 8/1/2014 STILL had yet to correct the errors aforementioned and therefore subscribers STILL do not have their ID cards. Therefore, there are bound to be ongoing problems with access to care, leading to canceled appointments and needless delay in healthcare all because an insurance company has an internal glitch that they don’t seem to be in that much of a hurry to fix. I received a call from someone in their problem resolution department after it was erroneously determined (from reading my initial blog entry) that as a provider I was having some issue with billing. That shows you how much they must have actually ready of my posting. I explained the actual situation and demanded that IBX offer a public apology from their CEO and also that they reimburse on a prorated basis every business affected by their error. Since that time, despite asking for a follow up call, I have received no further contacts. Not surprising, considering the source. I understand that any business is entitled to earn money. That’s what makes our country the proverbial “land of opportunity.” Opportunists, in fact, exist at every level of existence. For instances, there are opportunistic infections and parasitic infections to which we may fall prey, depending on health and physical condition. Insurance companies are like those very same opportunistic infections. Our best approach and treatment for this illness is prevention. Do it at the ballot box, write your representatives, Congress, etc. Start your own blog. Send complaints to the state insurance commissioner (http://www.portal.state.pa.us/portal/server.pt/community/file_a_complaint/9258) every time you have a bad outcome because of a health insurance company. Be an active agent of change.

Prior authorization nightmare

On July 8, 2014, I received a request for prior authorization for a patient’s prescription for Nuvigil (http://www.fda.gov/downloads/Drugs/DrugSafety/UCM231717.pdf), which is a wakefulness promoting drug used in conditions such as obstructive sleep apnea (http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/). My patient’s insurance is through Independence Blue Cross of Philadelphia (http://www.ibx.com/index.jsp). Usually, prior authorizations are processed by Future Scripts (https://www.futurescripts.com/FutureScripts/). On July 17, having not heard anything, I resubmitted, but again heard nothing from Future Scripts. During this time my patient, who was without Nuvigil, was also calling the insurance company. It was not made clear till July 21 that the company Restat (http://www.restat.com/contact/) was responsible for the prior authorizations. A representative from Restat called me to get my fax number, which I readily provided. I completed the form, faxed it, heard nothing by July 24, at which point I sent it again. I still heard nothing until 7/29, when I was contacted by Restat stating that “more information was needed” and they had not received that information from me. When I inquired what that information was and told the representative that I had twice faxed the form that his company had actually sent to me, he responded that they were trying to fax me but the fax was not going through so he was trying to clarify my fax number. Now, I had already received a fax successfully from Restat with what was presumably a request for ALL the required information. And yet, I was being told I had not provided all the required information, though the attempt to request it from me had been unsuccessful as well. Confused yet? Angry? Feel frustrated?

I explained the entire situation to the representative, expressing my concern that the patient had been without medication for the better part of the month as well as my anger and frustration that his company had now caused this patient harm. I told him that to wait 8 days for any attempt at resolution was inexcusable and unconscionable. He defended the company by telling me that they had a lot of requests to process when I asked why it had taken 5 more days after the receipt of my second fax to even respond to me. He listened till I was finished, then again politely requested my fax number, as if anything I had just said I might as well not have. There was no offer to get a supervisor for me nor any assurance that things would be corrected quickly. I hung up, as I had to begin my afternoon hours and could not wait the interminable period of time it would have taken had I requested a supervisor. I called my patient and left a message to file a grievance with the state insurance commissioner (http://www.portal.state.pa.us/portal/server.pt/community/file_a_complaint/9258). I was hoping Restat would overcome whatever internal incompetence had arisen so that they could request whatever information was possibly missing, though the form I had initially filled out contained as much data as is ever needed for prior authorizations. I had even included the sleep study report to prove the existence of sleep apnea in this patient. Though this story ends well – there never was a need for more information, and the prior authorization approval was faxed to me a short time later – it underscores again how insurance companies are playing a very active role in patient care without carrying any of the responsibility that comes along with being a doctor or other health care provider. As I asked in an earlier blog entry, who is monitoring these insurance companies? Why are they allowed to take 8 days to process a prior authorization claim (not all do, some respond to me within the day, though not always with an approval))? I urge all my readers to complain to your state insurance commissioner whenever there is a bad or even questionable outcome with your insurance company. Write to your representative and/or Congress to complain about the insurance industry and their protection under ERISA (http://www.dol.gov/dol/topic/health-plans/erisa.htm). That is the only way we can expect change for the better – get involved.

July 11, 2014
ERROR CODE – IBX HAS A NEW OPERATING SYSTEM
On July 1, 2014 Independence Blue Cross in Philadelphia () began utilization of its new operating system. Unlike the smooth operations of their other forms of utilization – utilization management, that is (retrospective case reviews prompting denials of care/payment, prior authorization policies), they are experiencing major glitches with the new operating system. ID cards, which should have been in the hands of EVERY member, are still not available. One local business affected by this learned earlier this week that IBX incorrectly loaded data files resulting in individual subscribers having their medical and/or prescription coverage incorrectly reflected in IBX’s system. Consequently, when providers check coverage status, the error makes its impact by hindering access to services that are seemingly not covered for that individual. Contacting the IBX help desk (1-800-ASK-BLUE) does not help, as operators were telling subscribers that “the employer” made the changes. That was apparently supposed to be corrected, as IBX had already admitted their error, but it should not be surprising that an insurance company would allow that to happen. When that particular business contacted IBX about this repeatedly, they were ultimately promised that the error would be corrected by the end of the business day on July 9. As of yesterday morning, July 10, the problem was still not resolved. Further contact lead to a promise that the problem would be fixed by this morning (July 11). As of this writing, there is no further news.

On November 8, 2013 IBX posted online a FAQ document titled Transition to New Operating Platform . So why, in July 2014, is IBX still not ready? Health care does not simply get paused like a You Tube video to wait for a company that has been woefully inadequate and inept with respect to their customer service. If you have any of IBX’s products and you have to seek health care, keep your fingers crossed that access to care is not denied. I urge all who read this article and are affected by this to begin complaining immediately to IBX. Ask your employers to complain and to keep complaining, every day, both online and by phone, or in person if you live close enough to their Philadelphia headquarters. There are simply NO EXCUSES for this. If you purchase a car with a navigation system, do you have to wait for the GPS company to upgrade before the system will give you your directions? No. This reminds me of the mid-1990’s when the internet was fairly new to the American public and those who used America Online (AOL) would have their internet experience periodically interrupted while AOL “updated its art work.” Remember those days? Sometimes, service would be interrupted and then one would have to undergo the tedious process of logging back on through whatever dial-up service was available. But this is 2014. Do you think IBX’s executive would tolerate ANY delay in the payment of premiums and other fees? Of course not. No pay, no insurance. Your benefits would be suspended. Does IBX, or any insurance company, for that matter, tolerate a provider’s coding error, for instance? No. Reimbursement is withheld, and explanations for why will vary depending upon who answers the phone when the provider’s office calls. So what is IBX’s consequence?

Who is holding insurance companies accountable? Why is this allowed to happen and all any of us can do is wait till they fix their error? Why was this not foreseen last November when they published their FAQ’s? Why has there not been a very public apology from IBX’s CEO to any and all subscribers and businesses affected by their ineptitude? How refreshing would that be if there was a public service announcement from IBX chief executive officer, Daniel J. Hilferty. After all, he did just earn the 2014 Southeastern Pennsylvania (SEPA) Citizen of the Year Award from American Red Cross (click here to learn more) for his support of the Red Cross and advocacy for philanthropy (click here to learn more). But that would be too much to expect. It’s very nice he supports the Red Cross. I just wish that the philosophy and values that underscore his philanthropy would pervade the corporate operations and help to establish a stronger commitment to the discipline of customer service. Back in the 1960’s, it took one person to go up against a large company after a major problem had occurred and things began to change. The Chevy Corvair, with all its problems, led Ralph Nader in 1965 to write the groundbreaking book Unsafe at Any Speed in which he chronicled unsafe practices in the auto industry. (click here to learn more). The Corvair existed from 1961-1974, but Nader’s book forced change to occur. GM harassed him and tried to intimidate him, but in 1966 then GM President James Roche was forced to appear before a US Senate subcommittee to apologize to Nader. So in answer to the question that opened this paragraph, WE are going to have to be the ones to hold insurers accountable. And unlike the 1960’s, or even the 1990’s, we don’t have to write a book to get noticed. Social media, when used properly, is a powerful tool. Go to IBX’s Facebook page and register your displeasure whenever there is some negative outcome attributed to their actions, such as not getting ID cards out in time because of a “glitch” or denial of a medical service or a medication (ibx.com/facebook). Also, call them out on Twitter at @ibx.

Hopefully, by the time you’ve read this the problem will have been corrected. And hopefully, there will have been no serious consequences. But I truly hope that reading my blog will spark you to take action whenever you don’t like the outcome your insurance company has delivered. Every person counts, every voice needs to be heard. Silence represents hopelessness, or worse, apathy and tacit approval.