Filed under the conundrum that is the healthcare system in America:
A couple of weeks ago, CenterWell, which is the mail order
prescription subsidiary of Humana’s pharmacy benefit management (PBM)
operation, emailed me that they were processing autorefills of three
prescriptions. Fine.
A few days later, I got a message from my PCP indicating
that she’d received the request for refill, but that it’s good practice to
check in periodically with patients on maintenance meds, so would I make an
appointment? Only—she’s not the prescriber for these particular drugs. I
replied asking if she wanted me to transfer the management from my other
provider to her; she declined for [reasons]. Fine.
(Well, actually, not entirely fine. Seems to me that she
could have looked at my history and realized that she is not, in fact, the
prescriber, and maybe reached out to me for clarification. I mean—the meds are
listed in my portal records; you knew there was a portal, right?—but there’s
clearly no record that she or any other provider in the practice prescribed
them. I know things get muddled when Amazon takes over, but still.)
So I called CenterWell to find out why this practice and
not my actual prescriber got the refill request and got through to a
representative who identified herself thus: “This is Betty [I’ll say], your
pharmacy advocate.”
I explained the situation—for some reason CenterWell
contacted my PCP and not the (sole-practitioner) specialist for the refill;
what gives? Well, Betty, my pharmacy advocate, put me on hold for a while and
then came back to say, no, they’d sent the fax request (they only do fax) to
[specialist’s] fax, so everything was as it should be. I asked why, then, did
it show up at PCP and not [specialist]. Well, she couldn’t say, because that’s
the fax number they have, so…
I replied that whatever number they have is clearly not
his, because it ended up at PCP. Betty, my pharmacy advocate, asked if [specialist]
isn’t part of that practice. No—he’s a sole practitioner and in fact operates
in a different state.
To give her credit, Betty, my pharmacy advocate, did try
calling him to find out what gives, but she got no response, as I knew she
would. He’s a sole practitioner and has appointments and no receptionist. She
returned to the line and reported her lack of success, and I explained why that
would be. I said that if she left a voicemail, he’d get back with her, but she’s
not allowed to get callbacks.
Again, she asked if I was sure that [specialist] isn’t
part of the (admittedly huge, found in many states) practice. I said no—the specific
PCP is in Virginia; [specialist] is in DC. Betty, my pharmacy advocate, didn’t
quite get that—what state? The District of Columbia.
“He’s in the state of Columbia?”
“No—he’s in the District of Columbia; our nation’s capital.”
Well—in the end, I could see that I was not going to get
anywhere with Betty, my pharmacy advocate, so I said I’d just contact
[specialist] and have him submit new prescriptions every three months, instead
of one 90-day script with a refill; would that work? Yes, she said (probably
relieved); that will work.
So I thanked Betty, my pharmacy advocate for her time and
emailed [specialist]. He called me back and we had a good laugh about it. I
knew he had, in fact, once worked for the gigantic PCP—like 10-12 years ago;
evidently that fax number (which is in the 617 area code, not 202 for DC or 703
for this part of Virginia) still appears in databases and the effort to correct
it is more than your life is worth. We agreed on the every-three-months plan
and there it is.
The thing about this encounter is that these gigantic
companies give their frontline customer service/pharmacy advocate people a
script and no agency so that they are not really able to provide service or
advocate. Betty, my pharmacy advocate, and her colleagues have no ability to do
anything that can’t be realized in real time—no voice mails, no emails, no call
backs; only what they can do while the customer is actually on the line with them.
She tried, within the strictures Humana/CenterWell placed on her, to help, but she
had no ability to move outside a very small box. It took two individuals—me and
[specialist] to work out a solution, which places the burden on getting the
products/services for which I pay Humana (market cap: $36.7B) delivered. Me, a
retired person, and [specialist], a sole practitioner.
Seems to me that this is kind of backwards, but they make
it so exhausting to even get what you’re paying for that trying to get them to
fix their system is just beyond the beyond.
You know—a conundrum.
©2026 Bas Bleu
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