Express Scripts seems to have a random number generator in their customer service algorithm: "One time out of every five fulfillments, let's just arbitrarily decide to deny our customer his benefits." At least, that's been my experience over the past two years. Most recently, I had my prescription denied at the local Walgreen's.
After waiting for 45 minutes on hold (better than average with ESRX, actually), I was first told that my doctor needed to have a prior authorization on file for that particular dosage. When I reminded the customer "service" representative that I've had my MD fill out said prior auth several times, she basically shrugged it off and told me I needed to have him do it again. At that point I asked for a supervisor and got "Jerry." That's when the real fun started. Jerry at first reinforced the requirement for a new prior auth, but admitted that when he looked up my records, there was one on file that was effective well into next year.
He said he needed to check on something, and went offline for a few minutes. His new angle upon returning was that a prior auth was not going to do any good, because this particular dosage was "not covered." My only option was to file an appeal. "But what changed?" I asked. I pointed out that I'd had the same RX and dosage filled in June and July at Walgreens, and over a dozen times at CVS.
All were covered. He had no answer. Did my employer change their coverage with ESRX? He had no idea, and there was no way to find out.
Could he send me something in writing or electronically that indicated that the dosage was, in fact, not covered? No. "Then, with all due respect, how do you know that it's not covered?" "I'm not here to argue. It's not covered." At that point, I asked to speak to someone who could answer the question.
He refused. "You'll get the same answer." I asked to speak to supervisor. He agreed, and put me on hold for 20 minutes. Came back and said it would take a while.
"I'll wait." While I was waiting, I plugged in my RX and the quantity onto the Express Scripts web site, and it quickly came back with "You're covered!" When "Jerry" came back, I told him this, and he basically called me a liar. Then he put me on hold for another 15 or so, came back and said he'd have someone call me. I said OK. That was about two weeks ago, and I haven't heard back from anyone.
Meanwhile, I paid the full price for the RX at Walgreens. I also filled out a request form on the company web site. I quickly got a response, asking if I wanted to pursue the appeals process. I responded immediately, and after a few days got an email notice that I had a response on their portal.
Sadly, their entire site has been down for a couple of days now (see photo). So I have no idea what it says. I also gave a negative review on consumeraffairs.com. I received a response from "Adam" via that site asking me for my phone number and area code, and and assurance that someone would contact me.
I responded with that information, and have had no response in over a week.
I realize this company is a $100B+ monopoly, and that's why they can simply charge what they want, decline coverage arbitrarily, and basically tell customers they can go to *** if they don't like the service. That is, unfortunately, the nature of a monopoly.
Product or Service Mentioned: Express Scripts Prescription Refill.
Reason of review: Poor customer service.
Monetary Loss: $85.
Preferred solution: Full refund.
I didn't like: No communication with patients, Dishonest employees, Lack of response.