Ugh.  Today just isn’t going to happen.

Thankfully, I am extremely blessed to have a partner in Ivonne.  She rises up to every instance she is needed and for this I am truly blessed and thankful.

Today I am supposed to be heading to Long Beach to conduct open Enrollment meetings for Bayfront Child & Family Services (an evolving service to the children in need in the South Bay community).  Instead, after a quick call to Ivonne, she confirms that she’ll handle the enrollment meetings today and give me time for some rest.  Phew.

I have a cup of tea and head right back to bed.  Well, I needed it.  I set my alarm for 10:00am, and get up to tackle some emails.

Mostly everything is running comfortably with the UA Team (Josh, Patty, Yleana and Alma) at the helm taking care of servicing our client’s needs.  It’s truly amazing how every day in this business brings so many different types of scenarios that need to be specially addressed.  I guess it is because we are in the business of helping people and each person we are here for has their own needs and issues as they try and sustain health and navigate the insurance roller-coaster they are on.

Well, since all is sailing smoothly today I decide to make use of the day and read up on what is going on in the industry.  News about what Trump is doing.  Research on what the trends are for rates the past few quarters are.  Digesting the product highlights and changes from insurance carriers.  You know, all of the exciting insurance stuff (right).

The one thing we know in the benefits world is that the waters don’t stay calm.

Today, as is the case many of our days, we have an issue with a subscriber not able to get their specialty medication covered by their insurance plan.  We actually expect this to occur and so we don’t panic too much as this is often an issue that can be resolved.  The unfortunate part of it though is that it is not usually fixed in the time that the person needing the medication wants it to be fixed.

A little known fact is that when a prescription is being denied at the pharmacy level by the insurance carrier, an appeal can be immediately submitted to get this fixed.  In this case, it is an infusion drug that is needed.  No alternative exists, so this is the one we have to get covered.  Well, here we go.

First, we complete a claim form.  Next, we need the doctor to validate the claim form by phoning the insurance carrier (phone number given to the employee to give to his physician’s office).  Once the doctor demonstrates that this is the only course of treatment he or she recommend for their patient, the insurance company reviews the scenario.  Now this is what few know.  Insurance carriers will issue the authorization 94% of the time if the physician makes their case for the medical necessity of the drug prescribed.  They key is, all the proper and energetic steps must be taken.

Patty is scheduled to stay on top of this and guide the employee through the process to hopefully reach a positive conclusion.

As the day winds down and the weekend is soon to begin, I start to relax my mind and take a breather knowing that now I can focus all of my attention on Lily.  It’s been a long week away from her and now I’m fully ready to engage in the always exciting and interesting world of a nine year old girl.

That’s it till next week.

Super-Agent out.