Minnesota Woman Battles Insurer For Access To Life-Saving Medicine

By Consumers for Quality Care, on June 23, 2017

Minneapolis’ City Pages recently reported one woman’s battle to get her medication covered by her insurer, Blue Cross Blue Shield of Minnesota. The experience, she says, leaves her furious.

I am furious. Furious that my insurance company preferred to pass me between divisions, departments, and parent companies rather than take responsibility for dealing with my case. Furious that I am forced to fight for medications to treat a disease that I never asked for and never wanted. More than anything, I am furious …my [quality of] life … is being determined by two large companies that clearly do not [care] about me.

Katie Nelson was diagnosed with narcolepsy after years of battling depression and severe exhaustion. After her diagnosis, Nelson recovered enough to build a new career working as a journalist oversees.

When she chose an insurance plan, she specifically chose one which included a “vacation override policy,” which would allow her to fill several months worth of prescriptions.

My new insurance policy seemed like a decent, albeit expensive plan, chosen for its low prescription copays and clear “vacation override policy,” which allows patients to collect several months’ worth of medication in advance before an extended trip.”

However, when Katie tried to use her policy she was denied.

No one at Blue Cross can answer [my] questions. In fact, they can’t even find a copy of my policy, much less interpret the fine print.

I spent countless hours on the phone with departments and divisions, attempting to clarify obscure policy details with representatives who often had no idea where to find the override policy in my plan. Or even what a vacation override was.

Eventually, she was told that she would need to bring her claim to Prime Therapeutics, a Pharmacy Benefit Manager owned by BCBS.

Despite being owned by Blue Cross, Prime often operates on a completely separate set of standards, which, in my experience, often contradicts those of Blue Cross.

Eventually, Ms. Nelson received the approval she needed to get her medication – allowing her to return to work.

While resolved for the time being, the experience leaves Ms. Nelson skeptical of the insurers’ practices and motives.

It was a grueling and deeply emotional experience that left me questioning whether anyone in the insurance industry even cared about the patients they were hired to serve.