Wednesday, July 21, 2010
I hate the American healthcare system. The biggest thing I don't understand is why people don't seem to have a problem with the concept of people (who aren't doctors or even researchers) making millions in the industry, with our very lives hanging in the balance. Do you really think the CEO of Eli Lilly gives a flying shit if you don't get the medicine you need? Or that the head of Anthem cries himself to sleep at night knowing that hundreds of people die every day based on decisions his company made so he could have more money?
Insurance is evil. More accurately: health insurance is evil. Insure your car, your house, your grandma's silver tea set, or even your ability to work in your chosen field. But why should the average person have to give up more than 10% of their income for health insurance that only has a slim chance of actually covering the actual care that would be best for them?
I digress. Yes, I had another Insurance Issue. DD has had diabetes for 10 months now. 10 months of diabetes meds and supplies prescriptions. I would say there have been maybe two months that I've been able to go to the pharmacy and pick up what I needed and go home without incident. 20% is not a good track record. I actually thought those days were behind us because we aren't on the state kids' medicaid health plan anymore. Until last month, DD had been getting her insulin through multiple shots every day. Then we finally got the pump approved. We went two weeks ago to the training session to learn how to operate it and get it started. We were instructed to bring a new bottle of insulin to the training session. Her script was up for a refill just a few days before, so I picked it up and we brought it with us. When you're on shots, you take 2 kinds of insulin: one quick acting one that you take before meals, and one long acting one as a basal (or "background") support throughout the day/night. This keeps the blood sugars from spiking up and down every time you eat. The pump works differently, though--it constantly delivers a teeny tiny dose of quick acting insulin so there's always a basal amount active in your system, then you get little "boosts" (they're called boluses) to accomodate the food you eat. So before, we were on two insulins, now we're on just one. Because of the switch, the one bottle that I'd gotten two weeks ago will only last us about 10 days, max (in a perfect world where nobody eats birthday cake or has hormones!). So the doc re-wrote a new script for the actual amount of insulin we needed, as well as new test strips that work in the meter that's integrated in the pump that we use. (Keep in mind here--this pump was covered 100% by the insurance company--a rare stroke of luck for us!)
I waited a couple of days and still hadn't gotten the email or phone call from the pharmacy I usually get when the script is filled. This chain of pharmacies has two locations in my town. One of them is open 24 hrs and is just 4 blocks away. The other has ridiculously short hours and is on the other side of town. As my luck would have it, back in January when we were getting brutally ass-raped by both the state medicaid and the Wal mart pharmacy, the Inconvenient Pharmacy was the only one that even tried to help me. I was so grateful that I swore to only get my scripts filled there. Finally, I had a late shift at work, so I decided I'd go to the pharamcy to pick up her scripts in the morning and get her pump reloaded before I left (she was literally on her last drops, and I'd only waited this long because I had no money to pay for it). I drive to the other side of town and arrive just as the pharmacy is opening. "Oh," he tells me, "It looks like they actually filled this one at the other location." Fuck. They called the wrong location. "Don't worry," he said, "I'll transfer it here and get it together for you." I wait patiently. A couple minutes later, he asks if I'd already filled a script for insulin this month. I explain the change in regemin, and that an override is needed for it to go through. So he gets on the phone to get his override. He comes back to the counter and informs me that the insurance company won't override the script because "they don't do overrides for dosage increases". (Mind you, paying out of pocket for all the insulin we'd need for the rest of the month would cost us about $450.) "You'll have to call member services to see if you can get them to override the policy." he said. It was like all the air was sucked out of the room. I just closed my eyes for a second and took a deep breath, and before I could say anything, he said, "Wait, I'll try another number."
Then I sat there for an hour while he waited for someone to call him back. I had to get ready for work, so I went all the way home, and by the time I reached someone in the insurance office, they said, "Oh, it looks like someone fixed that. They have your script ready now." Arrrrrgh!!!!
Insurance is evil. More accurately: health insurance is evil. Insure your car, your house, your grandma's silver tea set, or even your ability to work in your chosen field. But why should the average person have to give up more than 10% of their income for health insurance that only has a slim chance of actually covering the actual care that would be best for them?
I digress. Yes, I had another Insurance Issue. DD has had diabetes for 10 months now. 10 months of diabetes meds and supplies prescriptions. I would say there have been maybe two months that I've been able to go to the pharmacy and pick up what I needed and go home without incident. 20% is not a good track record. I actually thought those days were behind us because we aren't on the state kids' medicaid health plan anymore. Until last month, DD had been getting her insulin through multiple shots every day. Then we finally got the pump approved. We went two weeks ago to the training session to learn how to operate it and get it started. We were instructed to bring a new bottle of insulin to the training session. Her script was up for a refill just a few days before, so I picked it up and we brought it with us. When you're on shots, you take 2 kinds of insulin: one quick acting one that you take before meals, and one long acting one as a basal (or "background") support throughout the day/night. This keeps the blood sugars from spiking up and down every time you eat. The pump works differently, though--it constantly delivers a teeny tiny dose of quick acting insulin so there's always a basal amount active in your system, then you get little "boosts" (they're called boluses) to accomodate the food you eat. So before, we were on two insulins, now we're on just one. Because of the switch, the one bottle that I'd gotten two weeks ago will only last us about 10 days, max (in a perfect world where nobody eats birthday cake or has hormones!). So the doc re-wrote a new script for the actual amount of insulin we needed, as well as new test strips that work in the meter that's integrated in the pump that we use. (Keep in mind here--this pump was covered 100% by the insurance company--a rare stroke of luck for us!)
I waited a couple of days and still hadn't gotten the email or phone call from the pharmacy I usually get when the script is filled. This chain of pharmacies has two locations in my town. One of them is open 24 hrs and is just 4 blocks away. The other has ridiculously short hours and is on the other side of town. As my luck would have it, back in January when we were getting brutally ass-raped by both the state medicaid and the Wal mart pharmacy, the Inconvenient Pharmacy was the only one that even tried to help me. I was so grateful that I swore to only get my scripts filled there. Finally, I had a late shift at work, so I decided I'd go to the pharamcy to pick up her scripts in the morning and get her pump reloaded before I left (she was literally on her last drops, and I'd only waited this long because I had no money to pay for it). I drive to the other side of town and arrive just as the pharmacy is opening. "Oh," he tells me, "It looks like they actually filled this one at the other location." Fuck. They called the wrong location. "Don't worry," he said, "I'll transfer it here and get it together for you." I wait patiently. A couple minutes later, he asks if I'd already filled a script for insulin this month. I explain the change in regemin, and that an override is needed for it to go through. So he gets on the phone to get his override. He comes back to the counter and informs me that the insurance company won't override the script because "they don't do overrides for dosage increases". (Mind you, paying out of pocket for all the insulin we'd need for the rest of the month would cost us about $450.) "You'll have to call member services to see if you can get them to override the policy." he said. It was like all the air was sucked out of the room. I just closed my eyes for a second and took a deep breath, and before I could say anything, he said, "Wait, I'll try another number."
Then I sat there for an hour while he waited for someone to call him back. I had to get ready for work, so I went all the way home, and by the time I reached someone in the insurance office, they said, "Oh, it looks like someone fixed that. They have your script ready now." Arrrrrgh!!!!
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