EXPENSE OF MEDS

According to a recent search of the internet, a scum bag is a “a contemptible or objectionable person .informal, derogatory.”  That would make the insurance agent I just talked to a “scum bag.”  Now that I think about it, I’ve dealt with a lot of scum bags over the last 40 years.

Many of you will think I’ve gone too far. I haven’t! I’ve watched my patients suffer at the hands of health insurers.  There are patients whose testing, labs, and hospitalizations have been refused by insurers who make money as if they were printing it ($100 million or more yearly for one well known insurer in one state).  I’ve watched patients go bankrupt trying to pay for the healthcare they needed that their insurers refused to pay.

In reality, insurers never deny care. They simply refuse to pay for care.  If your insurer refuses to pay for your care, contest their decision strenuously. 

Renee takes an inhaler that is essential if she wants to breathe.  Initially, the cost to her was $42 per month (about 10% of their retail cost of approximately $403).  This month her portion increased to about $102 per month (now 25% of their retail cost).  Their formula to determine when you have to pay more is based on their retail cost of the medication.  When you reach their set threshold of the retail cost of medication in a calendar year, you are moved into the next higher pay basket.  However, to get past the “Coverage Gap” into the “Catastrophic Coverage”, the basket change is based on out-of-pocket costs, not their retail prices.  It sounds like they are mixing apples and oranges.  Maybe they are just speaking two different languages to further confuse us.

In addition to trying to understand the double speak, the scum bag on the phone did not speak English intelligibly. She gave an explanation which boils down to two main points.  Reason number one: this insurer can set the cost of care whenever they want to because they can.  Reason number two: the insurer seems more concerned with stockholder profits than the health of its members.

Please understand that Renee was a medical office manager for 30 years.  If she had trouble understanding the agent’s explanation, do you think the average patient can understand the rules?  Of course not!  There is no transparency in pricing structures. The rule book that is available to the public and almost impossible to understand gives the insurer a huge advantage.  About 20 years ago, a Federal Judge was reduced to tears as he tried to get his medication released by his insurer.  He had asthma and needed his medication but refused to pay for it as the insurer dropped his medication from their formulary which had been a covered benefit for 20 years. He wanted “justice to prevail.”  All of his legal expertise was for naught when it came to dealing with the insurance industry.  He eventually won but at a great personal cost.

When I practiced medicine, I was afraid of the insurance companies.  I would not have written this article for fear of retribution. I’m still nervous! I’m also spending a significant amount of my retirement funds on medication and healthcare. I know I am not alone.  Many of us saved for retirement to be able to cover our medical expenses.  Little did we know what was coming.

Here is today’s joke:

The fitness trainer asked me “What kind of squats are you accustomed to doing?

I said, “Diddly !!”

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2 Replies to “EXPENSE OF MEDS”

  1. I know those squats! I’ve tried the real ones. My knees said to me, you have got to be kidding. They were right!

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