Soapbox on the state of healthcare

Just as Steve's new opportunity was revving up, we were dealing with a huge presciption coverage crisis. Steve's previous company, always trying to be a pioneer, switched their health insurance to a Health Savings Account (HSA) model during their last open enrollment. We weren't sold, in fact, we knew it would be a disaster. At that time, I was unsure how much longer I would still be with my current employer and the coverage they offered was very heavy on in-network provider coverage. So we tried the HSA. I was hoping another opportunity was going to work out for me that ended up fizzling and if we had leaped on mine, we worried we would then need to get the HSA anyway if I left my company and then have to start loading up our account from zero right as cold and flu season hit. Epic fail. So we endured bills for $120.00 each and everytime our kids went for a sick child visit at the pedi. We both breathed sighs of relief when our "complimentary" annual exams did not result in any follow up because $$$$$. Steve hurt his knee and refused to get an MRI or see a specialist because $$$$. After several months of trying to avoid it and hoping we would hit our family deductible, he tried to renew his prescription for a very expensive injectible medication. His insurance company and the farmed out prescription provider (when did that happen by the way, seemingly overnight?!) argued and went in circles and ultimately, he could have had his medication, for $2100.00 for a three month supply of 6 shots. Unacceptable. There was a glimmer of hope at one point that he might be able to get it for $800.00. It would have cleaned out our HSA, but we would have been thrilled to get it for $800.00 and you know what, there is something really ridiculously wrong with this.

This all was happening during Steve's two week notice window at "big corporation" and I unfiltered myself and reached out to the Benefits Director who was working with Steve to try to get the medication for him. I gave her an earful. I wasn't rude, but I couldn't help myself. Someone had to listen to my tirade even if they were just going to delete the voicemail and do nothing with my criticism. As a young family, this HSA is such a pile of cow poop. Sure, we pay in each month to our own account and spend it how we see fit. Sure, that is what that money is for afterall, but $120 a pop to take your kid to the doctor? We spent nearly $600 in one month alone this past fall, well beyond what we would have paid for our old HMO coverage. In one month we had spent what equated to nearly three months of premiums with our previous coverage. I noted to her that this same medication had once cost Steve $50.00 with their previous insurance and over the years that cost had continued to go up and up and it didn't really feel to us that benefits were a priority anymore for "big corporation."

I filled out my paperwork to get our family on my plan at work; that restrictive in-network coverage plan we weren't sure about. Somehow paying for cobra coverage of this craptacular plan seemed worse than having no coverage at all. How bad could my coverage be compared to what we had? We crossed our fingers that this medication might cost less, we made sure our physicians are within the network, and we are hoping it will work out.

Steve called the other night to see what "crazy expensive injectable medication" would cost. He held his breath, I took the kids for a walk around the block anticipating a big long conversation demanding quiet and multiple transfers to supervisors. Within moments, $30.00. For a three month supply. $30.00.

What is WRONG with healthcare in this country that the same medication could cost a person $2100 and another $30? Same patient, same illness, same everything, different insurance plan. Ridiculous.

We don't have it in our hands yet and I am pretty sure we won't believe it until we have it here in our very own fridge. There are still some hurdles and paperwork to complete, but he is already closer to getting it than he was after nearly a month of trying with "big corporation's" insurance. In three days. I wanted to call the Benefits Manager to tell her, "Wow! Look at this, actual coverage!"  but what could that possibly accomplish?

1 comment:

  1. Utter craziness! Crossing my fingers for the future.