Express Scripts - Icing on the cake after getting laid off, incompetent, INSOLENT, and sad to say, benighted "customer service" agents.
Over the last three months my head has been left spinning trying to first inquire, then complain and finally to "educate" the people who answer the phone at Express Scripts. As other people have mentioned, when you call, the person who answers can't even comprehend simple questions related to coverage, much less company policies.
For all this time I have been struggling to be reimbursed for expensive prescriptions (over $1700 out of pocket) after being laid off and beginning Cobra coverage. I was laid off 7/11/2016 and I was informed and aware that it could take several weeks for the coverage to “kick in," and for my new information to show up in my pharmacy's system. My company was very communicative and specific while informing those of us moving to Cobra that we would have the exact same plan as we would have, had we not been laid off. Therefore, I did not worry too much about paying for my expensive prescriptions as we were told it would only be a matter of a few weeks for reimbursement.
My experience dealing directly with Express Scripts has been beyond frustrating and the stress and uncertainty they have caused could not come at a worse time since I’ve been with my company for 24 years and have never had so much as a hiccup when it came to dealing with Anthem BCBS as I have for over two decades. I have twice submitted my receipts to Express Scripts. (Note, they only accept fax or snail-mail submissions which is a SURE sign you are dealing with the bottom of the barrel). After my first snail-mail submission, I received a twenty-plus page document denying each prescription with instructions to fill out a separate appeal letter for each one.
The reason given was that I had submitted copies of digital receipts and not what was stapled to my prescriptions when I picked them up. (Pure BS, the information was exactly the same). BUT, my pharmacy was kind enough to reprint these for me and for this submission, due to time constraints, I only submitted the receipts for prescriptions of more than a nominal amount (I believe over $30). These still amounted to over $1500.
I submitted these via fax. The next communication I got from Express Scripts was a denial of payment for all but $317. Reasons given: "You have been reimbursed only what your plan would have paid this participating retail pharmacy." And, "The cost submitted for this medication is more that what your plan allows." Uhhhh, I don't think so! My plan is EXACTLY THE SAME as it was and I have been on all of the same prescriptions, filled at the same pharmacy for 10 years!
They attached the same “appeal” forms, asking me to fill out a separate one for each prescription, and snail mail them back. My attempts to get answers from anyone at the customer service number for Express Scripts has left me in tears. I have felt as if I’m speaking with a collection agency and not a company employed to offer a service to me. Although the plan documents linked to my account at THEIR OWN website show that my co-pays should be $20 and then ZERO after I’ve paid my out of pocket maximum (which I already had for 2016), the “customer service” agents refused to even attempt to explain why they are withholding my money, only telling me to follow this “appeal” process.
As a last resort, I contacted Anthem BCBS customer service because I have had nothing but exceptional experiences with their reps. As a legitimate company, they have the "online chat" option, of course you can call and after you have someone assisting you, of course you can continue with their private email account and can attach documentation digitally so the issue can be worked on in a timely manner. As per my prior experience with Anthem, the representative listened, responded sympathetically and after I forwarded her the letter I got for denial of proper repayment, she pledged to follow through with investigating this matter until I am finally reimbursed for 100% of what I have spent! This company is the University of Phoenix of prescription management companies.
If you don't know what that means, take five minutes to Google and you'll get it completely.
There are several ongoing legal cases involving Express Scripts including one where Anthem is suing ES. Lots more can be found.
Product or Service Mentioned: Express Scripts Prescription Refill.
Reason of review: Deliberately underhanded in processing claims reimbursement. Outright disrespect shown to customers by representatives..
Monetary Loss: $1700.