My uncle has health insurance through Healthfirst. Healthfirst has outsourced the administration of many medical authorizations, including for some of the medical supplies my uncle needs shipped to him monthly, to Integra Partners. Integra Partners has delegated delivery of my uncle’s medical supplies to Edgepark. Healthfirst, Integra, and Edgepark all suck. Today I’m going to tell you (the most recent example of) why.
Edgepark was supposed to ship my uncle’s monthly supplies order on July 30. Today, August 10, I discovered they still had not shipped, because Edgepark is (supposedly) still waiting for insurance authorization. This is the second month in a row Edgepark has claimed authorization was missing. The same authorization which finally got them to ship last month is still in effect; it hasn’t expired. There is no justification for Edgepark to claim that authorization is missing. And even if there were, it’s there job to get the problem straightened out, which they still haven’t done after 11 days. And if they couldn’t get the problem straightened out, it’s their job to contact my uncle or me to notify us that there’s a problem we need to resolve. They haven’t done that either.
This is at least the third time Edgepark has delayed an order. Before this started happening they were quite reliable about shipping orders on time. But something has changed. I don’t know what it is; all I know is that they are no longer capable of shipping orders on time, or of resolving insurance problems in a timely fashion, or of notifying patients when there are problems with their orders. None of this is OK (massive understatement).
After discovering today that Edgepark had yet again failed to ship my uncle’s order, I decided I was all done with this nonsense and it was time to switch to a new supplier. So I logged into the Healthfirst website, initiated a live chat with a member service representative, and asked how to switch suppliers. They said my uncle has the right to ask for his supply orders to be switched to a new supplier. To make that happen, I would have to find a new supplier in the Integra network, and then have the doctor send new prescriptions for my uncle’s supplies to the new supplier. Supposedly once that’s done, the new supplier will submit the new prescriptions to Integra, then Integra will approve switching the monthly shipments to the new supplier and notify the old supplier to stop shipping.
I asked, is there a directory of Integra suppliers I can search to find a new supplier? Nope, I have to call Integra and ask them to do it. I asked, can we just use the prescriptions that Integra already has on file from when these supplies were initially approved? Nope, new prescriptions are required. It’s almost like they erect time-consuming bureaucratic hoops which they offer no help with on purpose! Oh, wait, that’s exactly what it is.
So, OK, I call Integra. Miraculously, I am able to navigate their automated phone menu system and reach a human being relatively quickly. She asks for my name and a call-back number, and then before our conversation can go any further, we are disconnected. Lovely! So I call back again.
On the second call I am able to have a real conversation with a member service representative. When I tell her why I’m calling, she says, “I don’t see any record of the supplies you’re calling about in my system. You’re going to have to deal with Healthfirst directly.” I explain that I had just spoken to Healthfirst and explained how Healthfirst said this was supposed to work. She said, “Well, I guess we can try doing it that way and we’ll see what happens.” Lovely.
So she starts going through suppliers in Integra’s network, based on my uncle’s ZIP code. Apparently even the supplier network directory that the rep has access to doesn’t say which health insurance their suppliers accept or what kinds of supplies they are able to fill orders for, so for each supplier we consider, the rep has to put me on hold, call the supplier, and find out whether they can provide for my uncle’s needs.
Supplier #1 makes the rep wait on hold for a while and then transfers her to voicemail; she’s not allowed to leave messages, so she hangs up and comes back on the line with me to move on to supplier #2.
She gives me the name of supplier #2, and I ask her to skip them because I look them up on Google and their reviews are bad. I don’t want to switch from one bad supplier to another.
Supplier #3 answers the phone and says they don’t sell the supplies my uncle needs.
Supplier #4, appears from their address to be run out of an apartment. It has only one review in Google, which is obviously fake. I’m skeptical, but she tries to call them, and the call goes to voicemail again.
Then she informs me that Integra reps are only allowed to make three of these supplier calls per member per day, so either she can give me the names and numbers of some suppliers for me to try myself (including the ones we already tried that went to voicemail), or I can call back Integra tomorrow and ask whoever answers to try to call another three suppliers.
At some point during all this I asked the rep to check if my uncle’s fabulous local pharmacy whose staff knows and cares about my uncle and always does the best they can to help him, is in Integra’s network. Of course they aren’t, because why would Integra’s network have good suppliers in it?
Rarely does a week go by without me spending many hours (when I should be doing my actual job that I get paid for) dealing with problems like this on my uncle’s behalf. If it’s not this supplier and these supplies, it’s another supplier and other supplies. If it’s not supplies, then it’s prescriptions. If it’s not prescriptions, then it’s getting his electric wheelchair repaired. The problems never end. They almost always involve multiple phone calls to multiple entities, and they frequently involve the various entities disavowing responsibility and telling me that I need to deal with the others, if they even return my calls at all.
There was a time when my uncle was able to advocate for himself. That time has passed, which is why I deal with these things for him. If he didn’t have me advocating for him, he wouldn’t be able to get the care he needs and is legally entitled to.
I don’t know how people in the United States who aren’t rich and have cognitive deficits navigate the American healthcare system. Maybe they just end up in massively understaffed nursing homes that accept Medicaid, where they live in squalor briefly and then die? Given what I’ve seen from the multiple nursing homes my uncle has done rehab in, and from the nursing home my mom was in before she passed away, that seems like the most plausible outcome.
The American healthcare system, especially for elderly people, is terrible. It’s getting worse every day, and it’s going to get a lot worse before it starts to get better. If, indeed, it ever gets better.
