Thursday, June 29, 2017

It Takes Effort to Mess Things Up This Bad...

I grew up with a mom who is all about numbers. She taught Algebra 2 for years in our homeschool co-op, loves data and spreadsheets and graphs, and was a pro at on-the-go calculations of what percentage (and estimated foot falls) we had left of our 17 mile long run when we just passed the 4.5 mile mark. So while, I may not quite be the numbers expert that she is, I can make a decent effort.

So when I say that the probability of a pharmacy getting as much wrong as they did in a single week is just not statistically possible, you're looking at them actually having to put in effort to make as many screw ups as they did...

Leni's response to the hours I spent on the phone trying to sort 
this out...and yes, for those of you wondering, that is a 
Norwex dryer ball...also doubling as a service dog toy...
No, I'm not actually saying I think my specialty pharmacy messed things up on purpose...I AM saying that the odds of all this happening at once at not working in their favor. But you add to the equation how many times I've had similar mix-ups, and all of a sudden either they need some major quality control reviews or someone has some deep rooted bias against black fluffy poodles or large stuffed hedgehogs or slurpee consumption or some other randomly held belief. I'll leave you to decide which is more likely =)

At this point, you're probably wondering what the heck happened....I'm so glad you asked! Pull up a chair, sit back, relax, and get ready for some not-so-happily-ever-after story time. (Spoiler alert: It does end on a good note, so I guess it is happily ever after...until next time at least...)

So, some background. Because I have Mort (my port), I am able to give myself IV medications at home. I have 2 prescriptions that I get filled each month, these are ondansetron (aka zofran) and diphenhydramine (aka benadryl). To be able to give myself these IV meds, I also need other supplies one of which comes in the form of another prescription for saline flushes (basically 10 mL syringes pre-filled with sodium chloride that I use to flush my line before and after I use either of my meds). THEN, I have one additional prescription with this specialty pharmacy. My Xolair that I receive every other week is the last prescription I have on file here, but I do not receive this at home. This one ships directly to my doctor's office once a month with 2 doses at a time. Four prescriptions, one that I've been ordering for a year and a half, the others for going on 4 months now, NOTHING brand new. Ok, following so far?

This whole mess started two weeks ago. If you remember (and I barely do so it's okay if you don't), I was in MN the weekend before to see Dr. Afrin for my 6 month follow-up. My mom and I got back to Ohio on Tuesday and we had friends come in Wednesday to stay overnight, so Thursday was the first day I was able to call my pharmacy to refill my meds.

I called and we set up the order. For whatever reason they set it up as 2 separate orders in the system so I had one order with the zofran on it and a second order with the benadryl and flushes. I was told that they didn't have a full order of the zofran in stock, but they would send a partial order then send the rest once it came in. That was fine, but I made sure they understood that I needed these meds (however much they had) because I was going to run out over the weekend and these are a huge reason I have been able to stay out of the ER. The lady I spoke to assured me that the benadryl order would ship in full, no issues (remember the flushes are on this order...this will be important in a minute) but the zofran would be a partial order. Again, that was fine, so she submitted the order.


At this point I also asked about my Xolair because I was due for it in just a couple of days but my doctor did not have the next doses yet. She pulled up that order and said they were still waiting on one more authorization, but as soon as that came in, it would be good to go. I explained how important it was that I did not miss a dose, so she agreed to mark it as a STAT order which would hopefully speed things along. And that was the end of Day 1...

Friday comes and I get a phone call about 10 am to let me know none of my medications had shipped like I was told they would. This time, the reason was that the flushes were out of stock, so the entire order had been held up. Since it does not appear to be possible to talk to the same representative ever, I re-explained the whole situation to this new person. Apparently in less than 24 hrs, they all of a sudden had a surplus of zofran (while I was also told they had not received any shipments of it) so she would set up a special delivery for Saturday with the zofran and benadryl. She told me the flushes were out of stock (which no one had mentioned the day before), but they would send those as soon as they came in. That was not unusual because they don't always stock the pre-filled syringes so I expected that. Typically I would get a call the next day, and they would ship only a day or two behind the meds.

I, again, also asked about the Xolair and was told they were still waiting on something from my doctor, but as soon as they received it, the order would be good to go. I can only get my Xolair on Monday or Tuesday, so I had a *bit* of wiggle room, but not much. As long as they got what they needed on Monday, my doctor would have it on Tuesday and I could still get my injection in the afternoon, so I didn't push it.

Saturday, the zofran and benadryl arrived with no issues. I give my pharmacy maybe half a point here since it was delayed for no apparent reason.

Monday morning I called my doctor's office to see about scheduling my Xolair and see if they had sent what the pharmacy needed to ship. They said they had already re-sent everything twice the previous week, but had not yet received anything. I called my pharmacy and left a message for whoever I was supposed to talk to, but heard nothing. By the end of the day with no call back, they sealed the deal on me missing my Xolair this week.

Tuesday morning and I'm again on the phone with my pharmacy. Not only did my Xolair not get shipped in time, but I still hadn't heard about the flushes. Now, having my meds was great, but I cannot use my IV meds without having saline flushes. At this point, I'm getting to the point where I may not be able to use my IV meds if we don't get this sorted out in time.

I spent almost 2 hours on the phone on Tuesday. It appeared the pre-filled syringes were now in stock (yet no one called like they said they would), so the order was set up. I confirmed, double, and triple checked that what I was being sent were the pre-filled syringes and NOT the vials. I cannot use the vials for multiple reasons, so even though it is technically the same medication, they are useless for my needs. The person setting up the order confirmed multiple times that yes, he was sending out the pre-filled syringes and I would have them the next day.


Wednesday comes, the order arrives, and I had a partial order of the vials...they couldn't even get the wrong order right! BACK on the phone again...at this point, I have only a few flushes left until I would be unable to give myself IV meds. The person I spoke to on the phone listened to the problem, then came back and said since they had already sent out the vials and billed my insurance for them, they couldn't send me anything else because it would be double charging my insurance which would mean they would likely deny coverage for the second order...

While I may have had to give up a lot to my mast cell disease, one of the things that I have gained is the ability to know how insurance works and how to work around some of these issues. I calmly and politely (at least I was trying, okay?) told him that (1) I had called yesterday and double and triple checked this order was correct and was assured that it was (and that he was welcome to go listen to that recording if needed) and because of that (2) he needed to figure out how he was going to resolve this because it was not my fault that they screwed up, but it would be on them if I ended up in the ER because I didn't have the meds that I need since it was their mistake in the first place.

Please understand that it is never my intention to be rude or "that patient" when I call to resolve these issues. I wish everything could be resolved with a simple please and thank you, but that is not reality unfortunately. Had I not pushed this issue, I would not have received the meds that I needed and very likely could have ended up in the ER. I will readily admit my mistakes if something I did caused the error in the orders, but this was not my mistake and I should not have to suffer the consequences of them messing up. As a pharmacy, they need to understand that they are speaking with patients who rely on the medications they dispense to stay alive and function. Mess ups in our orders are not just inconveniences most of the time. These mistakes are the difference between ER trips and managing symptoms at home. So while I do my best to be polite and firm in these situations, I will push until things get resolved.

After going back and forth with the representative I was talking with and the pharmacy and his manager, I was finally told that they were going to need to call me back the next morning. I made sure to get a direct call back number and the name of the person I was speaking with before hanging up. Thursday morning, I did receive the promised call. He said they would be shipping out the pre-filled syringes to arrive on Friday and that they would deal with amending the billing with my insurance. I thanked him and told him that I was not upset with him personally and I did appreciate the work he put in to get this order correct. I do understand that the people on the phone are not the ones (usually) dealing with the actual medications, and I did appreciate him sorting everything out (eventually), but again, sometimes you have to be firm and push to get things fixed. I am willing to do what is needed to get these issues resolved, but I will also thank the people who do get things sorted out.

So, before I finish that piece of the story, back to the Xolair. After my very nice, but firm insistence that they figure out how they were going to fix their mistake, I got transferred to the right department to figure out what was going on with the Xolair. I was told the same thing again, they were waiting on documentation from my doctor. I told them that I had spoken with my doctor's office and that the paperwork had been resent TWICE already. She dug a little deeper in my file and discovered that, yes, my doctor had already sent the proper authorization...and she could even see that they had resent it two days later. Just out of innocent curiosity, I asked for the dates on the faxes from my doctor...okay, maybe not so innocent, but they had seriously exhausted the limits of my patience this week...who's been praying for patience for me recently?? PLEASE STOP! =)

You may have already figured out where I'm going with this, but yes, the faxes had happened with plenty of time to have shipped the Xolair in time for me to have gotten my injection this week...Somehow they got lost in the system and had I not kept checking back who knows if it would have even gotten sorted out for next week. This was too far removed from when things had happened for me to even begin to figure out what had really happened, so I just asked for it to be shipped as soon as possible. I did get the confirmation email that it had shipped to my doctor's office, and when I called to schedule Xolair for the next week, the nurses confirmed they had the vials. I give them a quarter of a point for this...if I end up in the ER because I had to go an extra week in between injections, I'm taking that quarter point back =)

Thankfully, the happy ending I promised happened about 1 pm on Friday when the pre-filled syringes showed up (more than a week after I started this process). (Although I won't mention that the UPS man left a cardboard box labeled 'medical supplies' sitting in the pouring rain...) So after hours on the phone and a week of confusion and mishaps, I do have all 3 of the meds that I need at home, my doctor has the Xolair. Now I can breathe a sigh of relief that I have 3 whole weeks until I have to do this all over again...

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