health insurance will kill me

[susandennis]

I am not smart enough for United States health insurance coverage. I can almost grasp enough of the medical part but the pharmacy part is just not comprehensible at all.

Last year my insurance company contacted me and suggested I switch to a cheaper inhaler. Fine by me. They even paid for it for the whole year. Coolio! But now, according to their website, they no longer cover it at all.

Ok.

Except. My PA sent the prescription in, as I requested, to Amazon Pharmacy. They filled it and when I went to check out, I was presented with two prices - $200 with insurance and $425 without. WTF? So they do cover it? But not much?

According to the Humana website, I have $100 deductible on drugs and Tier 4 drugs are $100 a pop. So I'm guessing that they do cover it and at the Tier 4 (Tier 3 is $47 and Tier 5 would be $132). The more expensive inhaler that Humana convinced me to give up would cost me $47.

I tried calling to make sure I was understanding correctly. I waited on hold for 15 minutes and then got a guy who didn't sound very confident in anything and finally, after about 20 minutes told me he could not access his computer and I'd have to call back.

On the up side, Amazon won't fill prescriptions for more than 30 days so instead of getting locked in for 3 months, I'm only in for 1 and I don't mind asking the PA to go back to Spiriva for next month.

It boggles me how everyone else copes with this shit. What if I didn't have $55 to waste on Humana's bullshit? COPD without money must be a barrel of fun. PHUCK.

Comments

[siglinde99.livejournal.com]

Wow. Almost anything I need is covered at 80%, with minimal arguments. The insurance company never contacts me about better options. I’m lucky that I have decent coverage. I feel for people with none at all.

[lifeinroseland.livejournal.com]

I am not smart enough for the system, either.

[bill-schubert.livejournal.com]

Thanks to this entry I called my Long Term Care company, Allianz, and asked for info that will end up saving us a bunch of money. I put it off because they are hard to deal with, hugely hard to deal with, and I'm afraid I'll screw up our policy which at the moment would pay off something like $350/day forever if one of us were unable to take care of ourselves. We've paid about $75k into the pot since we got the insurance and it is not an investment product so I'm terrified I'll do something stupid and give them a chance to kill it.
But I forged ahead and think I can save us about $1k/year by moving the elimination period from 7 days to 60. So many ways to screw it up.

[susandennis]

ohhhh that is a good change. Excellent.

Mine only pays $125 a day. Your inheritance pays the rest. So, sorry, in advance.

[bill-schubert.livejournal.com]

But I'm so grateful that I don't ATM have to deal with your situation. What a PIA.

[vysila.livejournal.com]

I'm not smart enough for insurance either. Spent a long time on the phone with my prescription carrier and couldn't get a straight answer out of anybody.

[susandennis]

Yep. Same.

[adafrog.livejournal.com]

{{{hugs}}}

[billinaction.livejournal.com]

It's hell! My mom just recent got coverage again and meanwhile we were black market buying inhalers from other people. COPD is hella expensive!!

[shutterbug.livejournal.com]

Wow, I just posted my own complaint on FB regarding meds and insurance before seeing this post. $&*()#$&

[nightcometh.livejournal.com]

It's almost like a free market would make things cheaper. Competition does wonders for prices.

[howeird]

Group Health (aka Kaiser) won't mess with your drug prices. Just sayin'

[susandennis]

My doctors don't work for Group Health and I'm not willing to change over this issue.

[howeird]

We have different mindset on this. I grew up with Group Health/Kaiser, and was always able to find doctors I liked, especially if I was dealt a dud. But whatever.

[zoefruitcake.livejournal.com]

I am so glad I don't have to worry about such shit because my head is swimming trying to.

[julesraimes.livejournal.com]

So very pleased we get it free - paid through our national insurance while working - but well worth it I think. Over 65's get prescriptions free. It makes me weep to hear how hard it is for you to work out the best price.

[susandennis]

Your system sounds so nice! :)

[maju01.livejournal.com]

I'm so glad we're with Kaiser. It seems like almost the next best thing to being in Australia with universal health care.

[belleweather.livejournal.com]

Yeah, I haven't worked in pharmacy benefits for almost ten years *boggle* but when I did basically plans had a limited ability to not cover drugs due to fancy state regulations, so instead of not covering them they either pushed them to the highest tier (4, 5 or 6 depending on your plan design), declared them to be "specialty" drugs and/or created requisites for getting them, so you have to try and fail on cheaper drugs before you get the expensive ones.

The reason it changes so often is that the Pharmacy Benefit Manager re-jiggers their agreements with the drug companies either 2x or 3x per year, depending on what they're allowed to do. What they Pharmacy Benefit Manager tries to do is negotiate volume pricing for the entire book of business -- so everyone covered by your insurance company and any one else they contract with. So they say like "We've got 40 million people who need insulin, and 20 million people who need beta blockers. Give us X discount over-all, and we'll make sure they take YOUR insulin and YOUR beta blocker." and then go back to the insurance companies and say they can reduce copayments on this insulin, if they raise them on this other one and email all their members pushing them to the cheaper option. If the PBM can deliver the volume, the prince will stay low. If they can't, or someone offers them a better deal, everyone has to switch again. Whee! Isn't pharma fun?

[susandennis]

Interesting. Makes sense and makes my head spin.

[chocolate-frapp.livejournal.com]

I'm on Medicare and Medi-Cal which is confusing as all fuck and there's a lot it doesn't cover, like, for example, anything dental. When I was younger I used to wonder why so many poorer people had bad teeth. Now I know.

[letmesaythis.livejournal.com]

And what if you were dealing with that bullshit when very, very sick? Unfortunately the U.S. healthcare system is structured to actually and truly kill the sick. I'm convinced.

[susandennis]

Yeah, if I were sick, I think I'd just do the #takemejesus deal and give up.