Navigating a prescription drug plan can be difficult, but Barbara Stonewater was sure she had it figured out.
Last year the Aurora resident used AARP's Medicare Part D plan, run by UnitedHealthcare. Under the "preferred plan" option, her copays were significant, but the drugs she takes regularly were covered.
In the fall, AARP announced a new coverage option, the so-called super saver plan. The new plan included a deductible, but the premiums were lower.
The website offered a tool by which she could enter her prescriptions and compare how much they would cost under each plan.
Both of the drugs Stonewater takes regularly showed up as "formulary" in the new super saver plan, and after adding up her costs, she determined that plan would save her money. She made the switch in early December.
Stonewater said she called UnitedHealthcare and was told she needed her doctor to send in a pre-authorization letter showing Celebrex was necessary and appropriate for her treatment.
She called her doctor's office, which said it faxed the letter.
Almost two weeks later, Stonewater called UnitedHealthcare for a status check and was told the insurance company had not received the doctor's fax. She said she was told that a pre-authorization letter wasn't necessary, but instead she had to file an appeal.
Again Stonewater talked to her doctor's office, which filed the appeal Feb. 7, she said.
In late February she called the insurance company and was told the second fax was not received either, she said.
"I flat out don't believe that because my doctor's office gets a receipt saying (the fax) went through," Stonewater said.
She called UnitedHealthcare on Feb. 22 and was bounced between different departments for almost 21/2 hours, she said. The last representative proved particularly unhelpful.
"She kept reading irrelevant information from her prompt sheet and when I finally told her that I didn't think she had any idea what I was asking, she hung up on me," Stonewater said.
With her hopes for resolution dwindling and her patience strained, Stonewater posted a message to the Problem Solver's Facebook page.
She said that if Celebrex is covered, as the website said it would be, it would cost her about $500 this year. If it isn't, it will cost her an additional $1,300, she said.
"This is not a cheap drug," she said. "It's a big deal."
Stonewater said she would have stayed with the preferred plan if the website had shown Celebrex is not covered by the super saver plan.
UnitedHealthcare did approve a 30-day supply while it reviewed her situation, and her doctor gave her 20 sample pills to tide her over, she said. Those pills will run out by mid-week and she had no confidence her situation would be resolved by then, she said.
"It's the most frustrating thing in the world," Stonewater said. "You can't get beyond customer service. They won't let you talk to anybody else and they can't resolve it. … I just want a decision so I can figure out what to do."
The Problem Solver called Kevin Shermach, a spokesman for UnitedHealthcare, who promised to look into Stonewater's case.
On Friday, Shermach emailed with good news.
"After researching this issue, it has been determined that this drug will be covered under Ms. Stonewater's plan for 2013," Shermach wrote. "We are grateful for her patience and understanding."
A relieved Stonewater said she received word from UnitedHealthcare on Monday morning.
"The woman who called me didn't even bother to say we're sorry this was such a pain for you. She probably didn't even know," she said.
Still, she said, "It's in my formulary for this year. I'm covered."