Speaking Up For Yourself

Laurie: Speaking up for yourself

Laurie, 30, had struggled with acne since she was a teenager. She tried many different medicines, but had problems with the side effects. Then her doctor recommended a new drug with fewer side effects. But at the pharmacy, Laurie learned that her HMO didn’t cover the drug, and she would have to pay $200.

Laurie called her HMO right away. “The first person I spoke to told me there was nothing he could do. So I asked if there was anyone else I could speak to. After talking to three different people, I finally managed to get hold of a supervisor.” The supervisor faxed an authorization (pre-approval) form to Laurie’s clinic and Laurie made sure the nurses faxed the form back right away. Laurie was told that the HMO would send the authorization to the pharmacy in three days.

But after three days, the pharmacy said they had not received anything from the HMO. “I was annoyed. But fortunately, I had written down the name of the supervisor at the HMO, so I was able to get her on the phone directly.” Laurie’s persistence paid off, and she was able to pick up her prescription the next day. “It wasn’t an easy process, but I didn’t give up. I knew I wasn’t asking for something unrealistic. It’s something I should be able to get.”

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