The Joys of Medical Benefits



I have a new medical provider. The days of arguing with Kaiser are long gone. The king is dead - long live...... huh? That's right - now I am arguing with CIGNA.

Earlier this year it seems that, for some unexplained reason, CIGNA terminated my pharmacy benefits. Despite the fact that I continue to pay them. I found this out, not by CIGNA contacting me with some nice letter, something to the effect of "were sorry you have decided to leave us...." bla bla bla. No, I found out when I went to renew a prescription and was told by the pharmacy that according to CIGNA I had been terminated in March of this year.

After a number of phone calls and arguments it was finally straightened out. Apparently there was a database error. You see, the customer benefits database (the main database) is not what is used by the pharmacy. The pharmacy uses, the pharmacy database. Somehow, my record in the Pharmacy Database had a flag set which indicated that I had been terminated. CIGNA reps assured me that they had updated the Pharmacy Database and all was well again.

Now, this weekend my wife went to pick up my prescription renewal and guess what? That's right - I was terminated. When? March of this year.

After a couple a phone call to CIGNA, the rep discovered that - wait for it........ there was apparently a database error. You see, the customer benefits database (the main database) is not what is used by the pharmacy. The pharmacy uses, the pharmacy database. Somehow, my record in the Pharmacy Database had a flag set which indicated that I had been terminated. CIGNA reps assured me that they had updated the Pharmacy Database and all was well again. The rep went on to tell me that there were no indications of any updates or transactions to my pharmacy records since the April update which resulted in my March termination. Sound familiar? Are there any Database Administrators out there that can explain this?

Now, I am no rocket scientist, but I have had a few database courses in my time and I can explain this. It's simple. The database crashed, or was updated, or reloaded with old data. You would think that a resync with the main database, or re-ingesting of transactional records would be the next logical step - but obviously not in the case of CIGNA.

Posted: Mon - August 14, 2006 at 12:39 PM   If this blog entry was of use to you, why not show your appreciation by donating to support the site? Just click on the MAKE A DONATION button on the right hand side of the page! It's all handled by PAYPAL.
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