...Or You Could Pay $4,150.00 Out Of Pocket

Every new year I go through the same game of trying to get my leukemia medication.

The game goes something like this:

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-approve it for the new year.
The insurance re-approves it (which usually takes a week or two)
     However, they only re-approve it for the first month
I pick up my medication
     However, I need to have my doctors fill out more forms and fax them in over the month so I can hopefully get my medication the next month without any hassle.

This year the game was changed up on me.

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-aprove it for the new year.
The insurance re-approves it (which took about a week and a half) BUT ONLY IF I RECEIVE MY MEDICATION FROM THEIR MAIL IN SPECIALTY PHARMACY

"Okay, Fine." I think to myself

So I call the specialty pharmacy who tells me they do not have my prescription and need my doctor to re-fax in all of the information including my co-pay assistance card.

My doctor faxes in all the information, insurance/copay cards in on Wednesday of last week and I am assured by the new pharmacy that everything will be ready to go within 24 hours.

On Friday morning I call, because I haven't heard anything and I figure I better check in.

I speak to a woman who informs me my copay is $4,150.00.

I tell her my co-pay assistance card helps with that and she tells me they do not have my co-pay assistance card on file. Frantically I give her all the information over the phone and she tells me she has put an "emergency" note on the file to get this shipped out to me.

I hear nothing.

So Monday morning I call to check back and am told they have all the information in the system and to check back at 4pm (Pacific Time) to make sure the medication goes out tonight.

I call at 3:50pm (Pacific Time) and a new person tells me it will take another 7 Business days for them to "verify" my co-pay assistance--- OR I COULD JUST GIVE THEM $4,150.00 AND THEY WILL SHIP IT OUT TONIGHT


I hope each and every one of you has that kind of money laying around for one month's worth of medication--- but I'm guessing I'm not the only one who does not.

The only way to get any of my Daily Leukemia Drug for the month of January is to have them over-ride the system and allow my regular pharmacy to go ahead and fill the prescription.

I ask them to do this--- and they tell me they are only open for another half hour so I need to call my local pharmacist, have her try and run the prescription through the system, get a denial number, call them back with that denial number, and THEN they can release it to her so she can order the medication for me to receive before February 1st.

I hate to make assumptions--- but isn't it convenient that the insurance company doesn't have to pay anything for January if they can't have the drug approved until February?

My local pharmacy originally tried to re-fill the prescription on January 10th. The December prescription ran out on January 14th. Today is January 28th.

Anyone else see a problem here?

Health Insurance and Profits: Capitalism is not to blame

Today I read this article in the NY Times:

http://www.nytimes.com/2013/01/09/business/health-care-and-pursuit-of-profit-make-a-poor-mix.html?pagewanted=all

For those who read this blog and The Malformation of Health Care book http://www.amazon.com/dp/B009V37CXU  you already understand my position on what this article says (the author is preaching to the choir).

I find it fascinating that no matter how many discussions, articles, programs, books, take on this topic; these companies still have the audacity to continue acting in bad faith.

What will it take for incredibly high powered, well lobbied, excessively wealthy companies to become accountable for bad practices?

I'm sickened to say, probably "nothing".

Despite the claim that corporations are people, corporations (especially on this high of a financial level) do not have an internal moral compass. Most people who work for these companies are at the mercy of this corrupt system just as much as the customers who pay their premiums each month in hopes their policy will cover them should tragedy strike.

This is not capitalism. This is greed.

The reason I say this is because I know what the ideals of capitalism are, I grew up on them. My family owned a small hardware store for over 100 years. The reason the company lasted for 100 years was because of the pride taken in our services and products. We didn't force anyone to shop at our store, but we gained loyal customers, based on our integrity.

We offered competitive prices and guaranteed our products and our work. If a customer came in to the store and said a product was faulty and we didn't either exchange the product or fix the issue, we would have been run out of town. No customer would have shopped with us.

When a health insurance customer comes to the provider with a problem, many times they are ignored, avoided, or told of a previously undisclosed "loophole" that frees the insurance from all coverage obligation.

Capitalism only works when those servicing the population understand that first and foremost they are performing a service for the community. Profits come when that service is performed well. If that service is performed poorly, profits should be reflected.

That is capitalism.

That is not what is going on currently within our health insurance system.