Insurance

Insurance. What does that word bring to your mind? To your mind, it may bring the idea of medical bills getting paid. It may bring to mind of deductibles. It may bring to mind that once-per-year maze of paperwork that your employers insists you course through.

For me, it brings a headache. Since I have recently changed employers, I changed insurance. Simple enough. Fill out some forms. Submit them. Fill out the corresponding questionnaires. Submit them. I wait. Receive a letter with insurance cards.

Then comes the letters that state my insurance will not cover pre-existing ailments. What?!?! I thought that’s what HIPPA was all about.

Call the insurance company. Question them why they sent me these letters about pre-existing coverage. Resend HIPPA forms showing previous coverage. I wait.

Go to Walgreens for prescription refill. Walgreens explains that this medication will require pre-authorization with my new insurance.

Call insurance company and request explanation of pre-authorization of prescriptions. Am told that my prescription is not on the insurance formulary and will cost much more since insurance will not pay without pre-authorization. Insurance then explains that I should try one of the two medications that are on the formulary and treat the same symptoms. I explain that I’ve tried those medications in the past and they have not helped me. Insurance company is dubious of my statements and requests that I have my physician call them.

Go to Walgreens and learn that they have faxed my physician’s office a request for pre-authorization. Question physician’s office. They explain they have contacted the insurance company for pre-authorization.

Call the insurance company again. Discover that they have medications divided into tiers. My prescription is a Tier 4 which requires pre-authorization and additional documentation. Request pre-authorization. I wait.

Insurance company explains pre-authorization was granted earlier in the day and local pharmacy should be able to run prescription. They also explain that Walgreens will soon be removed from their authorized pharmacies. They gratuitously suggest alternates.

Go back to Walgreens. Walgreens explains that they have not received authorization. I explain my discussion with insurance. Walgreens runs the prescription again and discovers that it is now processable. The insurance is paying $43 of a $200 prescription. I’m thinking I pay the insurance company $100 per paycheck to insure me. The prescription will be ready in thirty minutes. I’m frustrated because I requested the refill four days ago! Nevertheless, I wait.

Receive my prescription and realize that I’m only receiving 30 pills, even though my physician wrote for 90. I realize that $200 is for a one month supply. Pharmacist explains that insurance will not allow dispensing 90-day supply.

Leave Walgreens and call the insurance company. Insurance company explains that they will not allow local pharmacies to dispense multiple months of prescriptions at a time, but their mail-order can. If I utilize their mail-order, I can receive a 90-day supply of my medication for $120. They will simply need a new prescription sent to them.

WOW! My new insurance company feels that they can better diagnose and treat me than my local physician and pharmacist. I don’t get It! And government insurance is going to be better?