KOK Edit: Your favorite copyeditor since 1984(SM)
KOK Edit: your favorite copyeditor since 1984(SM) KOK Edit: your favorite copyeditor since 1984(SM) Katharine O'Moore Klopf

Wednesday, November 09, 2005

Inside the Hell of Express Scripts

Remember the extreme lengths I've had to go to to get AD/HD meds for my husband and one of our sons from Express Scripts (ESI)? If not, this, this, and this will refresh your memory.

Tonight I heard from Rachel bat Avraham,* a courageous Express Scripts employee who's been following my Express Scripts saga here:

Hi, Katharine.

I've been reading your blog, especially your Express Scripts posts. I'm glad you got some help finally.

Keep hounding those newspapers, and magazines, and government officials.

And yes, we slaves on the phones at Express Scripts give our real names; at least I do. And, for [the] record, I always try to do my best to help every person I talk to during the day, even if I end up helping so many people I can't remember names or details.

Unfortunately, in a lot of cases, even if I know ESI is at fault, there's usually nothing I can do about it, because there's no way to get around the rules. Trust me—the folks higher up on the totem pole (as well as most of the agents) don't give a damn about the folks on the outside getting the short end of the stick from ESI.

I know it's probably hard to believe that anyone's sincere at ESI, and I can't blame you. But I can say that there are a few of us who are sincere and will even take the responsibility for ESI's screwups in the name of helping the caller. Admittedly, it's very exhausting trying to correct unnecessary problems all day, along with being yelled at by supervisors who have been promoted to the level of their incompetence, as well as being cussed out and threatened by [customers], but I for one will not do a half-assed job.

I would advise any of you out there who are fed up with Express Scripts to continue to hound the media and turn it into a public affair, because I promise you, the higher-ups won't like the bad press. And if you do it, you don't risk being tossed out on your can without any unemployment.

I'm glad to know that Rachel cares and is doing her best in a no-win situation. It's too bad that she's not a supervisor. But having ethics and being competent probably disqualify her from being promoted. She wrote me later tonight about being a cog in the Express Scripts wheel: "Usually nobody gives a damn about us [customer service representatives]. We're just 'you people!' Today, though, I got upgraded to "you G-d damned people!"

You can contact her here or peruse her blog to read about what her days at work are like.


*This is an alias I've used for the employee's protection. You can bet that if Express Scripts knew her true identity, she'd be out of a job immediately.

Updated 12:45 a.m., November 10: Read about other consumers' Express Scripts nightmares here and here. There are plenty more such stories out there, but I don't want to sit here and insert hyperlinks all night.


Fighting for the Little Guy, Part 1

Fighting for the Little Guy, Part 2



Al DeVito said...

I dropped them a couple of years ago. They were one of the most incompetent organizations I've come across.

Katharine O'Moore-Klopf said...

I'd drop Express Scripts in a heartbeat if I could, Al. Unfortunately, GHI, through which I have health insurance, has a contract with Express Scripts, so I have no choice.

Anonymous said...

I just won a judgement in small claims court against express scripts. I got sick of calling over and over trying to get them to pay for covered meds. Small claims is great because they are too incompetent to show up which leads to an automatic adjustment. Now to collect...anyone know their corporate bank?

Katharine O'Moore-Klopf said...

Congrats, Anonymous! You've made my day. Unfortunately, I don't know who Express Scripts banks with, but try an Internet search on a phrase such as "Express Scripts corporate headquarters," and see what you can find on the sites that turn up. Hey, you might even try "Express Scripts bank." Please let me know how it works out.

Anonymous said...

I work at ESI and was shocked to see that the rx system is so driven on holding onto every last cent at the cost of there patients. I've decided instead of quiting I will now keep track of problems that I see and the ways these alleged errors are actually built into the system. If you have had troubles with ESI contact your benefit manager and complain repeatedly ESI is contracted out and if the account managers and benefit managers get over taken with complaints instead of the patient just letting it go they will fix more problems. Yelling at the PCA who takes your call does nothing they are just there to take the call and give you a bunch of bull in less than five minutes or they will be fired. I hope justice is found for all who deserve honest effective medical care.

Anonymous said...

These people take the cake. Unfortunately, the State of Michigan (need I say more) contracts them for prescriptions. They change the rules as they go, telling you that you need pre-authorizations on re-fills, demand everything you take go through them. I see why, they are a stock company and are making a fortune off screwing people who are stuck with them. I will talk to my union about getting them change. As far as I am concerned, we should get our prescriptions in MIchigan to help their economy. But those governments contracts, gotta love em.

Anonymous said...

i worked also as a pca and the higher ups and the way that screwed up place works was absolutely un-professional i felt bad telling patients there was nothing I could do for the error ESI had caused when it was clearly ESI's error I never wanted to leave a job so fast.

Anonymous said...

Dear "EditorMom"

I wanted to share my on-going situation with ESI.

After visiting with my physician and walking away with 13 prescriptions (3 for my Wife) I attempted to print out the Rx submittal form and they all printed with no information pre-filled. I then had to complete all 13 form by hand listing my name, address, city, state and zip code.

I mailed those prescriptions to the Bensalen, PA location - irregardless of the fact that I live in Kansas and there is a pharmacy in St. Louis - Huh?

I mailed the prescriptions on approximately September 25th. On October 6th or 7th I received a phone call from ESI to tell me that my order would arrive on October 9th and that I would need to be home to sign for the order.

I stayed home yesterday and waited for the delivery. And I waited, and I waited. Finally, I checked the ESI website and I checked on the delivery company site. Guess what, ESI had shipped the meds to the wrong address.

I called ESI and spoke with a person who took my information, put me on hold and proceeded to check out what happened. He returned to the phone three or so minutes later and actually voiced his dismay that he saw they had my correct address and they sent the order to the wrong address.

At first glance it appreared that the shipment had not been delivered and that he would attempt to redirect the package to the correct address. He came back to me and reported that he had been successful and that it would be redirected.

Afterwards, I rechecked the ESI website only to discover that there were actually two packages sent. The delivery had been split into two separate packages.

I called ESI once again and tried to explain to the ESI "rocket scientists" what the situation was. Needless to say but this call was all downhill. The end of the call came after the CSR Supervisor told me that I had ruined "her" day.

I was absolutely livid by now. I tried calling every number I could find at ESI corporate headquarters. They must know better than to actually answer their phone. Every call automatically went to voice mail. I left my name and phone number so they could return my call. Ha!!!

Around 5:30 p.m. on Oct. 9, someone called and apparently tried to correct the situation. God knows I should have known better. This woman told be that she would contact the Bensalem facility and have the situation resolved.

Around 6:30 p.m., a guy called and "told me" what terms I had to accept before they would correct their own error. In the end I told this guy not to touch my order - one way or the other.

Today, I went back to the ESI website and I saw that they had deducted one of my refills to correct their error. What?

Once again, I made the mistake of calling ESI. Now after I've missed two days of work ESI tells me that I will need to miss the third day to sign for another package - "a package that contains a chilled med." Never have I had to sign for a "chilled med."

They threatened me with not delivering the order that they sent to the wrong address unless I would swear - "on a bible" - that I would be home to sign for the package.

They are really clueless.

So after all this, I still don't know when they plan on correcting their own error.

I hope everyone puts this sad tale in their newspaper and/or website.

Anonymous said...

I had the dishonor of working for this miserable company for 9 months. It was more than I could take. During that time, I experienced such ignorance and racism, because I was Jewish, that it absolutely blew my mind! Has anyone else had the same pleasure?

Anonymous said...

I used to work for Express Scripts for four years, from 2004 - 2008. First let me say that I loved my job. In saying that, I hated the company that I worked for. Express Scripts is one screwed up company to work for.
I would like to clarify some things about Express Scripts. First, they are not your prescription insurance company. They are hired to manage your prescription benefits. At Express Scripts, they do not determine what medications require prior authorizations, nor do they determine the prior authorization process for your health insurance. Health insurance companies determine what medications are covered, the amount of each medication that is covered, and the prices on the medications that are covered.
Express Scripts basically manages each insurance plan. Now, for more on Express Scripts.
Yes, they mess up orders all the time, lose prescriptions, ship orders to incorrect addresses, lie to the patients about the status of their orders, and basically make most of the patient care advocates look stupid. You can find a lot of advocates that really do care about the patients, but unfortunately, they do not have the authority or power to correct the company's mistakes.
If you think that the patients get the short end of the stick, then you should try working for this company. The politics within the company are so discriminating and unethical, it makes me sick!
The best thing that I can actually say about the company is that they had excellent health benefits/insurance and an awesome 401(k) plan.... but that was not enough for me to put up with their politics. Married managers sleeping with their subordinates (proven!), upper management using the company credit cards for personal use and gifts, sexual harrassment by upper management.... I could go on forever.
All I can say about this company is it is the worst company ever, and really does put its patients health at risk.

Anonymous said...

hi, I found your blog about ESI. We just switched to them this year and I think I need blood pressure medication to deal with these idiots. If anyone can help me resolve a major complaints or point me in the right direction, that would be great. They shipped me rx for my son that I didn't need and they won't accept it back nor will they refund my money! UGH!

Anonymous said...

They did the same thing to me. Yesterday I received a bottle of pills that I used to use, but don't anymore. My prescription ran out last year and in March they apparently contacted my old doctor and somehow got him to issue a new prescription for this med that I no longer take. They shipped it to me without my knowledge and charged my credit card. Of course they swear that I ordered it and said that it is their policy to never issue credit. I called today to have my credit card number erased from their system and told them to remove all of my prescriptions from their system, as I no longer use any of them and I don't want them to send me some more of them behind my back. I'm also contacting my doctor's offices and telling them to document in my chart that I don't want them to respond to any communications from express scripts, because I would rather go to Costco and pay cash than to deal with this company. I could go on forever about all they have done wrong, but I will spare you. This last one must be illegal. How can they get away with renewing and refilling an old prescription without my consent?

DuckieGurl said...

I worked for this hellhole of a company for well over a year and I am going to warn everyone out there who may be looking for a job -- DON'T GO TO ESI LOOKING FOR A JOB!!! Let me share my story...my son was born with hydrocephalus which in turn requires the usage of a ventriculoperitoneal shunt. At times, the shunt can malfunction or fail which means that his neurosurgeon must correct the problem. I discussed this issue with several individuals in upper management and I was told that when it happened, I would be given an automatic leave of absence because of the fact that the hospital that my son's neurosurgeon works for is well over 2 hours away from home. In December, his shunt failed and I was given an LOA. The beginning of May, it was discovered that the entire shunt was completely infected and in turn, would require that he be hospitalized for a much longer period of time. I was given another LOA by one of the managers...however, I had gotten a call the following afternoon from another manager who stated that she was reversing the approved LOA because she didn't feel that it was medically necessary for my son to be hospitalized for such a long period of time. She then gave me the choice to either quit or be fired because she stated that there was nothing that she could do. I told her that I wouldn't quit, so she fired me even after I faxed documentation from 2 different surgeons who stated that because of the infection, we'd be stuck in the hospital until everything was ok.

Aside from all of that, the company's policies on how the pharmacies are run are completely insane and in some cases, unethical. If anyone wants more information, I will bookmark this page and come back to it -- and if you're in need of help trying to get them to do something, let me know - after workin' there, I have a few tricks...

Anonymous said...

I also droped them and decided today to find out just who really owns this corp. I spoke with a public affairs mgr named maria palumbo (never got the corp or individuals names)@ 314-684-6438 who kept insisting she needed my phone number for someone to phone me back. NO WAY! They have made getting my med's even more difficult since I went back to my local pharmacies. I have 4 different and very serious health issues and express scripts doesn't care nor does Macys the company I am on permanent disability through. I feel that they Macys) would rather see me die than get better since I have been denied the medicines I honestly need and they have decided to help express scripts substitute my medicines with generics from who knows where and just made me feel worse. Try getting Brand name medicines and see the costs express scripts expects you to pay. Of course I always wonder what corporate exec's medical insurances are like? What happens when they get ill? I'm sure they're treated a hell of a lot better than the rest of the cattle. NO 3-4 phone calls from express scripts to them saying your med's are on the way, being up to a month late in delivery, causing you more medical costs for doctor co-pays and prescriptions to hold you over til express gets off their butts and finally sends out whay they've been telling you has been mailed so many times you just get burnt out.

Anonymous said...

I'm the anonymous from yesterday. Before I became so ill I could no longer work, I was a "collector." Before I go further, please understand my people were NOT allowed to abuse delinquent accounts in any way or form or I personally walked them out the front door!! If you want information on the board of directors of express scripts try typing "investor relations-express scripts.com-board of directors-investor information.

Anywawy....I spoke to a very kind gentleman in california today who is a public relations person for the new insurance coverage law President Obama signed into effect. He gave me a quick overview...It's the corporations that contract with express scripts that call the shots on your personal coverage. The gentlemen I spoke with also informed me that he has received many calls regarding express scripts, Anthem Insurance Company and even Macy's. All I wanted to know was, if I change to another insurance policy does Macy's still have to pay their share of my monthly insurance. Guess what folks (for those that don't already know) the corporaton you work for has the final say in which insurance company you choose. So in fact, we the "cattle" still have no control over our coverage. The corporation can set the same standards on any insurance company you want to choose. I still think Express Scripts should be put out of business and plan on continuing my fight with them.

Also, I'm going to do the same to Anthem and Macys, followed by letters to all of my states Representatives. It's gotten to the point that I'm contacting all of the local news acnhors and this states main newpaper.

People that know me and my background would tell you all that I'm a nice person until every last button has been pushed, then all hell breaks loose. My ducks are lining up! Good luck to all of you in your dealings with the nightmare of Express Scripts. I hope they get shut down as quickly as possible.

TANT said...

Can anyone help by providing a name and contact at ESI that can fix my wifes perscription services?

The problem:
ESI will not pay for any perscriptions from our "chosen" pharmacy when our Military Facility does not cary the medicine prescribed.

Tried to resolve this several times over the phone but everyone we talk can not help fix it. They only recommend filing a claim. Well we did that and it was denied. Adding to the frustration they directed us to discuss any copayment discrepency with the pharmacist...

My email is thomasj39@comcast.net.

Unknown said...

I am so glad I found your site today. I want to thank you for being brave enough to tell it all. I unfortunately have fallen in to the cracks here also with Express-Scripts. As of today my class 2 scripts are still missing and they have been sent out a month ago. No one knows where they are. I am so sick of this and it has had my nerves so upset that I have been having chest pains over it. This is not the first time I have had problems with my scripts being missing but it is only the class 2 that come up missing all the time. I feel like I am alone and I am going crazy. The lengths I have had to go through and the multiple times it has happened make me look like I am a criminal or something. For years this has been happening and you have no idea what I have gone through and have to go through when it happens. It never has happened with my normal heart medications, etc just class 2. One time I sent in 4 class 2 medications scripts and no one could find them. There were times that I counted my meds and found them to be short also. I have had to file police reports,credit report, etc because of them. What was more embarrassing was the fact that the police looked at me like I was lying or guilty. They wrote that it was suspicious activity on the report and it made me feel like a criminal. I have been taken these meds for many years because of muiltiple medical conditions and so was my husband. Now he has passed away and it's still happening to me. Right now it's a month and they still do not show my scripts as being received. I have sent numerous emails and made many calls and still I have not found my class 2 scripts. My Doctor is a very nice Doctor but he has standards and requirements that have to be followed because of the classification of the medications. If I come to him and tell him they are lost I have to file a police report. If I have to do this more than two times I loose my Doctor. It's not his fault and I in no way blame him but this is ridiculous what I have to go throw. My nerves are shot and I have been crying because once again, my scripts are lost. I can't even begin to tell you how many times this has happened to me. I am so upset and embarrassed plus what I have to put my Doctor and his workers through to write more scripts because of Express-Scripts. Just since January I have had 3 times of filling my meds and each time there have been complications and questions about where my scripts are. It seems that Express-Scripts still has not learned their lesson yet. Now all my scripts have to be written over again. I am consideing not filling class 2 meds at Express-Scipts anymore because of the stress and what I have to put my Doctor's office through. I use them because I need to save on my scripts but no matter how I do it, (Such as registered mail) they can still say they didn't receive them. It will still cause my Doctors office to have to go through more aggreviation of writting them over. I would still have to have proof that those scripts were actually in they envelope when I mailed it which means I have to find a trusting source to validate the sending of them. It's going to cost me several hundred dollars to do them monthly but it's better than going through what I am at this time.

Unknown said...
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Unknown said...
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Unknown said...

I just finished calling Express-Scripts fraud hotline. The number I was given gave me every option but the option to file a fraud report. After spending all the time on the phone I ended up having to hang up and call the regular number. Again I had to go through a representative and tell her what was going on! Again I was taken to a supervisor who says "sorry but we are not showing them received and have followed the steps to ensure that your Doctor's office knows and will write new ones!" She also stated that she was filing my complaint for me. I told her I want to know where my scripts are and not just get new ones. I waited the last time because someone had my scripts and kept telling me they were mailed back to me due to my husband's passing away and having to re-enroll under a new member ID number. I kept calling and emailing and I was told so many times they were mailed. I waited weeks for them and finally I get them back. What really P O's me is the fact that they were not mailed back when I was calling, they were sitting on someone's desk. They were post marked 2 days after my final call which means they could have pulled them and filled them if they got off their butts and looked for them. Someone put in the system they mailed them out but they didn't mail them out. It wasn't until I raised such a fuss as (I have done before) that someone finally searched for them and mailed them back. Had I not constantly hounded them, I may nevewr have received them at all. I think this whole Gov. classification on these kinds of meds is screwed up. These kinds of classified medications should never even be released to the patient. They should be written and sent directly from the Doctors office to Express-Scripts so that they are secure. Express-Scripts should pay for this also if they want to get our money. They could send a tracking company to our Doctors office once or twice a week to pick up our scripts therefore there would be no questions as to whether the patient has sent them. We can fax things that aren't as classified but I don't understand why the classified is put into peoples hands to begin with. Then once our scripts have been filled and we sign for them, we are taking responsibility if anything happens to them once they have been filled. I also suggest to everyone out there that they count thier meds when they get them. I have come up missing classified meds and I never knew I could report it. I took the loss because I thought once I signed it was now in my hands. It wasn't until months later I learned I had a time frame to call and have them replaced. Frankly it's beginning to look like we need to have a amoured truck pick them up and deliver them. Someone needs to find a better way that is less stressful to us. One of my medical conditions is worsened by stress and you can't imagine the pain I am feeling because of this crap that keeps happening. I honestly feel the Gov. needs to find a better way and more secure way of dealing with classified medications. Then there would be no question as to whether the scripts are lost, stolen, etc. They should only be allowed to be sent directly from a Doctors office and not put in the hands of patients. If done this way then there is no way those out there who are abusing these drugs can copy the scripts or sell them. It's the innocent people who really need their medications who are paying the price for those who abuse them and sell them and it's not fair. Maybe if we get a bill together and submit it they will change the regulations on the handing out of the scripts and allow the Doctors office to mail them directly and then we the consumer would not be as stressed and worried, nor would we look like a criminal when Express-Scipts looses our scripts. Also again I stress that Express-Scripts should pay for the shipping cost of certified mail.

Unknown said...

Over a year ago I had to cancel my bank card that I just received for the new year. Do idenity theft calls because during that time we used our SS# on those scripts. I had every bit of my information on those 4 scripts and no one could find them until I requested an investigation. It was found that a Pharmacist had them. However even though I received an email stating they were at fault, I still to this day do not know what the outcome was. Did he loose his job? I have the documentation that this is what happened and I have the police report also. I also have copies from Express-Scripts of the scripts that were supposedly lost and found in the possesion of one
of the Pharmacist. I also told them that I had been missing 37 of my class 2 meds the time before and that is when I learned I had a time frame to report that. I also learned at that time that they no longer required us to put our SS#'s and credit card info on our scripts and had come up with the ID# which we didn't know about.
Recently I have learned that although we mail our scripts to the place on the refill form, they are not being filled at that location. That Express-Scripts has outside sources filling the scripts and where we are sending them is just a place that does the data entry of them and scanning them. Then the scanned copy of them is sent to one of the outside sources by fax, computer generated form and then they get pulled and filled. How nice to know that your talking to someone on the phone about "where are my scripts?", only to find out that there are several outside pharmacies (that are not located within the same place / building where your hard copy is) that is filling them by the same form of which our Doctor's office is not allowed to send them (faxed or computer generated)!!! I will warn all of you that unless you make a fuss about your scripts when they don't show up then you may never find them.

Anonymous said...

This is for Theresa. I don't understand why your doctors office can't fax your prescriptions to express. My doctor does it for the only medicine I still get from them (I've transferred everything else to local pharmacies). Is it a state law where you live? If not, try that. I can't even begin to tell you how much I hate express scripts. They HAVE to be put out of business. I wonder if theres a way we can all band together and file a lawsuit against them? Anyone out there have any ideas?

Katharine O'Moore-Klopf said...

Anon 7/23: If a prescription is for a controlled substance (such as some of the ADHD meds taken by my husband and two sons), federal law prohibits pharmacies and mail-order medication suppliers from accepting faxed prescriptions, because some people try to get such meds illegally and then sell them on the black market. The law requires that the prescription that is presented to be filled be the original. It sounds as if some of the medications that Theresa is talking about are controlled substances. Several times, Express Scripts "lost" my husband's and my sons' prescriptions for controlled substances. They magically "found" the scrips when I threatened to go to the media or to government agencies.

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