Thursday, September 27

Pain in the HIPAA

Perhaps you are unfamiliar with HIPAA (Health Insurance Portability and Accountability Act.) Perhaps your only experience with this evil incarnate is that bushel of papers handed to you when you see a new physician for the first time. Perhaps you glance at it once, casually, before throwing it away a week later after it develops coffee rings from its impromptu nesting place on the kitchen table.

Perhaps you are not me.

If you are unfamiliar with HIPAA, you can read the Wikipedia entry. Or you can simply take me at my word: HIPAA is a federal privacy policy enacted by minions of the Dark Lord. It has turned the simple act of getting one's own medical records (or one's own minor child's medical records) into an excruciating process less appealing than, and not nearly as productive as, sticking flaming toothpicks in one's eardrums.

Having sparked your interest, I'll cut to the chase. This is not the worst HIPAA experience I've ever had (that honor goes to my experience with Aetna, in the blog archives.) That makes it worse, actually. This is routine.

Last week, my daughter had an medical procedure done at the local Children's Hospital. I knew enough to request the HIPAA release form up front, at the check-in desk. I filled it out (officially giving myself permission to have copies of the medical records.)

Today, I called Medical Records to inquire about the status of this request. (They claim records are available within 1-5 days of request; I waited 9.) First the lady in Medical Records told me there was no HIPAA release on record for my daughter. When I insisted, she put me on hold. Five minutes of Muzak later, she returned. She found the release, but it was missing my address.

Now, I do not recall the form even asking for my address. However, to avoid any problems, I told her I'd come pick up the records in person-- no address should be required, just my ID.

No, I can't do that.

Okay, I'll give her my address over the phone.

No, she can't alter the form.

Well, for goodness' sake, why on earth did the check-in lady who witnessed the release not notice it was missing this crucial, earth-shattering piece of information?

She's not used to the forms.

Pardon me, but she's handing them out, witnessing them, and filing them-- perhaps she should become used to them!

Finally she said I could fax a new release. She faxed me a new release form, and I filled it out (incidentally, it was different than the original form I filled out.) Then I realized the cover page had no return fax number. I called the hospital main line, got the fax number. Faxed it back. Called Medical Records to make sure the fax was received. A different lady answered (naturally, the original woman had left for the day.)

Yes, the fax was received-- but I would have to mail the original to them.

So what the heck was the point of the fax?!

Calming myself, I told her the original form was already on file, minus my address. "Oh, then that's okay," she said.

So . . . apparently an actual original signature can be missing from the HIPAA Holy Writ, but an address cannot.

This, you see, is the beauty of HIPAA. Only Satan could've figured this one out.

Giving CVS The Boot. And Finger.

Yesterday I (don't laugh) tried dropping off another new prescription at the new CVS. I used the drive-thru and had to use one of those vacuum tube things. I put the prescription into the canister and placed it into the slot; there are buttons so I could press Send when ready. Except the pharmacy tech decided to be Speedy Gonzalez, and turned it on for me . . . before my fingers were clear. The tube smashed my finger as it began its ascent.

It was still throbbing when the pharmacy tech informed me (ready?) that the medication was not in stock, but they could order it.

My temples began to throb, too. "You know," I said fruitlessly, "this is literally the fifth prescription I've dropped off here, and the medication has never been in stock."

You know what she said?

Yup. "We're a new pharmacy."

I went to a different chain and had all the prescriptions transferred over. So long, CVS!

(They tried to screw me on the way out. New Chain called to let me know CVS transferred two prescriptions, but had no record of the other two. I had prescription numbers for those, so with a little legwork, New Chain got it done. Hurrah!)

Sunday, September 16

CVS: Incompetent & Dangerous

Okay, now I'm breaking out the big guns. I have had it with CVS and their ineptitude!

While visiting family in California, we've had occasion to need both refills and new prescriptions. Here are some of the ways CVS has disserviced me:

• A brand new CVS has opened within spitting distance of where I am staying with family. Charlotte had 0 refills left on her Prevacid, so I needed the GI doc to call in a new prescription. I asked whether it would be easier for CVS to (a) have an out-of-state physician call in a new rx directly or (b) have the dr. call our Maryland CVS and have it transferred to the California CVS. The pharmacy tech told me (a) was easier, so that's what we did. She took the doctor's number. Four days later, they still didn't have the prescription, and insisted they simply could not get in touch with anybody. I finally called myself, got in touch with the appropriate doctor, and had the prescription called in the same day.

The result? Brand-New CVS didn't even have the Prevacid in stock ("We're a new pharmacy"), and transferred the prescription to a farther-away CVS anyway. I could have saved 4 days and driving time if they bothered to check this information in the first place. I asked to speak to a pharmacy manager and was transferred to someone else; I asked if he were the manager and was told, "No. They haven't hired one yet. We're a new pharmacy."

• I went to the Farther-Away CVS to pick up the Prevacid. It comes in the form of dissolving tablets; for infant administration the tablet is placed in an oral syringe and mixed with water. Maryland CVS usually gives me a few syringes with each refill, and I reuse them until the rubber stoppers break and/or the inside has so much Prevacid residue it's purple. I asked Farther-Away CVS for some syringes, and the pharmacy tech had no idea what I meant. I described the syringes (brand name, color, size.) No idea. She offered me a dropper; I pointed out that the tablet cannot be placed into the dropper.

She fetched a second tech for me, who managed to find an oral medication syringe . . . except it was 1/5 the size it should have been. It was too small for the tablet to fit inside. I pointed this out, and the tech called for the pharmacist.

The pharmacist asked me "what my problem" was. I explained the situation. She came out from behind her counter to my side, looked around, and then shouted to another pharmacist, "Where do we keep the oral syringes for sale? This lady doesn't like our free ones!" The pharmacy was crowded, with a long line of patrons, and all eyes were on me.

My eyes popped out of my head. I announced loudly, "Excuse me. The ones you've offered are too small to fit the tablet! I'm only inquiring about what my regular CVS offers me. You don't have to make it sound like I'm throwing a fit because I'm so picky I don't want your syringes."

Then the pharmacist turned to me and said, loud enough for the entire pharmacy to hear, "I don't have to take this from a customer. Pick up your medication and go."

"I'm going," I snapped. "CVS is apparently staffed by morons, coast to coast!" Okay, it was rude. I was also sleeping sitting up in an armchair with a refluxy baby, and hadn't had more than a consecutive hour of sleep in a week.

• My older daughter needed a refill of her regular medication. Fortunately hers was a straightforward transfer and the drug was in stock at the Brand-New CVS. I discovered that this CVS did in fact carry the (free) oral syringes and asked for a handful.

• A week later, I took a prescription for an additional reflux medication to the Brand-New CVS. It was a new prescription, and I dropped it off in person. Several hours later, I got a phone call. Brand-New CVS did not have the ability to mix a liquid suspension ("We're a new pharmacy"), so they were transferring it to Farther-Away CVS. Oh Lord.

I picked up the new rx at F-A CVS. So far, so good. Took it home and administered before bedtime as ordered (thanks to one of my trusty new oral syringes, safely hoarded.) Except the baby wouldn't swallow it. Took a taste; gagged on it myself. Called the F-A CVS, which is fortunately open 24 hours. Pharmacist and I discussed flavorings (it is compounded with baking soda and tastes like bitter ocean water.) He said he'd call the flavoring company to ask about whether he can flavor this drug; promised to call me right back. Before we hung up, I noticed and mentioned that there was an error on the prescription label and asked him to confirm the dosage. He paused. Put me on hold. Came back. The medication had been compounded at ten times the prescribed dose. My jaw dropped. He told me he'd look into it and call back.

90 minutes later I called him again. It was now 11:00 p.m. Flavoring company hadn't gotten back to him. But he looked into the compound and thought the dosage was done properly after all; it was just a typo on the label. Forgive my skepticism. I wanted the med re-compounded. I'd be in touch tomorrow. Doctor ends up taking kid off the new med, don't bother following up on this one.

• Doctor called in yet another new rx (Pepcid) to the Brand-New CVS. A few hours later I called to ask if it's ready to pick up. Oops. They don't have the liquid suspension available ("We're a new pharmacy") . . . no, really. Transfer to Farther-Away CVS? Sure, why the hell not.

I got to pick this one up from F-A CVS without incident.

• Baby developed unrelated infection. See Urgent Care. See new rx. See Meg cry. See Meg be stupid and drop off rx at Brand-New CVS. See B-N CVS call Meg and explain they don't have this medication in stock. Seriously. I cut her off. "Look, I know you're a new pharmacy and all, but presumably corporate gave you some actual DRUGS before you opened." She said "Sorry."

As long as I had to get the prescription at F-A CVS, I called in the refills for both the Prevacid and Pepcid. They called to inform me they were all ready for pick-up.

When I got there, the Pepcid had not been reconstituted (it was powder in a bottle) and they had mistakenly given me half the amount of Prevacid they should have. Good freaking thing I realized both of these things before I left.

• Urologist wanted baby on prophylactic antibiotics. Finally wise, I skipped B-N CVS altogether and dropped off the prescription at F-A CVS. The tech read it and pointed out that the PA who wrote the script made an error. At 2 mL/day, the total 250 mLs she prescribed would be a 125-day supply of medication, which is highly unusual. Fine, I said, just give me 60 mLs (standard 30-day supply.) She had to check with the pharmacist.

Nope, she said when she returned. The law does not permit them to alter a prescription. The doctor's office had to be contacted; they could confirm or change the prescription. I checked my watch; 4:30. The office would close in half an hour. She said she'd fax them immediately.

I wandered around CVS for twenty minutes. I looked at the pregnancy and ovulation tests (my hobby.) I read the brochure for Jitterbug, the cell phone designed for elderly people. I checked out their stock of automatic blood pressure cuffs. I looked at their compression stockings, canes, and hemorrhoid cream. Finally I returned to the counter and asked the tech whether the dr.'s office had gotten the fax and cleared up the error.

"Oh," she said, "I don't know. The fax is in the back, so I just wait for someone to bring me my faxes periodically." My temples began to throb. I asked if she would check, given that I had been waiting ten feet away for 20 minutes. She did, looking inconvenienced. No, there had been no response. Too late for today; I could try again tomorrow. I asked for a pharmacist.

The tech left and returned a minute later. "The pharmacist who said I had to call them went off-duty, so I asked another one, and he said just to give you as much as your insurance will pay for."

Surprise, surprise. Insurance paid for a 30-day supply . . . the 60 mLs I had asked for, the 60 mLs that "could not be dispensed" because it was "illegal" to "modify a prescription." Yeah. That.

On the way home, I stopped at B-N CVS and asked for a handful of oral syringes . . . I have developed a habit of this, so I now have quite a nice little supply. I am rationing them carefully, yet I ask for "as many as you can give me." This is my way of sticking it to them.

So there you have it. From sea to shining sea, my experience has been that CVS pharmacists and its technicians are rude and poorly-trained (or simply incompetent.) Its shelves are poorly stocked. They have made potentially dangerous errors in dosage/dispensation of drugs for infants. They fail to return calls, review prescriptions before accepting them, or contact doctors for clarification in a timely manner. They have little sense of urgency for sick children. And finally, I am breaking free. Took me WAY too long.

CVS: sucks!