I am a career Firefighter/ Paramedic with a Metro Atlanta Fire Department. My son is a very High-Risk Infant who was born 11 week premature and was 2 pounds 6 ounces. With that came a whole bunch of medical issues of which a very Fragile respiratory system is the most dangerous. My insurance is with United Healthcare and I am so far pleased with them. ( it should be noted that until she had to quit work to care for my son- primary coverage through my wifes employer, was BC/BS and there was nevaer an issue with them or any of their providers) My son has to have Synegist vaccinations every month from October til March as prescribed by Doctors to protect him from RSV, which could be easily fatal to a High Risk Infant. Synegist must be administered every 28-30 days without fail to be 100% effective.
UHC unfortunately contracts with CVS/PROCARE/CAREMARK/PHARMACARE for these type medications and they have to be shipped to the Dr. office.
To make a long story short. UHC and CVS are currently in a contract dispute(at least in my case) on proper payment amount. Everyone agrees to this fact. Against their contract with UHC, CVS has even attempted to bill me for the difference. It is also an agreed fact that this is a matter of contract negotiations and does not include my son. HOWEVER, according to several supervisory level CSR's and account reps for CVS, they refuse to send my son's medication until this med is paid for in full by someone. That's correct, "we will not release the medication until this is paid in full". This was on Wed. Feb 18 2009 at 7pm est and the med has to be at Dr. Office by 830AM 2-24-09. Basically, if it is not sent by noon on thursday it will not get there on time. When the CVS rep was presented with this fact she simply said She understood but "sorry"- She would have a "supervisor" call me tomorrow (She never asked for my phone number until I asked what number he was going to call)
Let me be clear. UHC has a contract with CVS to provide certain medications for patients that are sent to the doctor's office. They have a contract that specifically states the price agreed upon, and that they are clear that no matter how much they charge for the medication, thay will accept the assigned price agreed to by themselves and UHC. That is where the descrepancy is. While on a conference call with a Senoir UHC rep and a Senior CVS rep, they all agreed that this was obviously a miscommunication between the 2 companies and would be resolved at an Administrative level. I the asked for clarification... this was clearly an issue between a provider and an insurance company and either way there was absolutely NO PATIENT RESPONSIBILITY, They both agreed. I then asked, so over a contract issue that had nothing to do with a baby boy you (CVS) would still hold a vital medication hostage as leverage against UHC... the reply was "I will not release this medication until it is resolved".
The UHC healthcare rep then pleaded with the CVS rep that this had nothing to do with the patient and the patient was being punished in this case. She agreed but STILL REFUSED to approve the shipping of the medication.
I asked both reps whether or not there was a clause that stipulated that CVS only had to furnish vital medications if it felt like it and were completely happy with their contract. Both agreed that this was not the case. But, that is exactly what happened. CVS has a contract with UHC no with me or my child!
My pleading has fallen on deaf ears with CVS thus far, so I am going to use some language that may get their attention.
CVS has a legally, morally, and ethically binding contract to provide critical medications to the clients of UHC. There is no where in the language that gives them the right to WITHHOLD CRUCIAL, TIME SENSITIVE MEDICATIONS from anyone, especially a baby- this is true no mattter the status of their business relationship. CVS is WILLFULLY, AND KNOWINGLY COMMITTING A BLATENT, ADMITTED (3 times in one conversation) ACT OF NEGLIGENCE. CVS is willingly and knowingly jeopardizing the health and safety of my child.
The 28-30 day window for this medication will close on Tuesday feb 24 at 0830 am. After that time my son will have been intentionally put at risk by CVS because they all of the sudden do not want to comply with a legally binding contract that they enetered into with UHC. No one disputes that there may be a payment issue (that will be resolved administratively)and no one disputes that the patient is not involved, nor owes them anything. But CVS still plans on withholding a very important medication from an infant and willingly put him at risk. That needs to be addressed in a swift legal fashion. I plan on circulating this story everywhere I can find and I intend on seeking recourse in whatever fashion I can. Please Help.