Tuesday, March 5, 2013

You just don't know yet what you don't know

Our health care / insurance system in this country is f__ked up!  I'm sure those of you who don't have insurance already know this.  But for those of us who DO have insurance, don't get to feeling too cocky.  You have NO IDEA what you really have, and what you don't.

Case in point:  This morning I went to my doctor for a Rx to kick this nasty sinus thing I have going on.  I took my Rx to Walgreens and they filled it and charged me $60.  

"Ummm....hold on there Kemosabe.  My copay is $5 for generics and $30 for name brands.  Why $60?"

"Duuuuh....I dunno.  Call your insurance company.  Bye."

So after tracking down a phone number and calling my insurance company's pharmacy contractor (Medco) and pressing 1 for this and 2 for that ad infinitium, they told me my Rx was a "non-formulary".  

WTF does that mean?

A formulary is not a generic, but just a preferred medication for a particular ailment.  They said if my doctor had prescribed SdkcmklemmnXK instead of SienbldoebdmLD it would only have been $5.

Now how the hell was I supposed to know that?

It's like when your doctor calls your insurance company for "pre-certification" before a procedure, that doesn't mean squat.  The insurance company will only tell you AFTER the procedure if everything that was done is covered.

So they're gonna tell us the rules AFTER the game is over?  Yep, that's the way it works.

This is bullshit!  The doctors / hospitals / pharmaceuticals / insurance companies don't want us to understand what's going on.  They like living in the shadows amongst the small print and arcane medical code.

We need some across the board, understandable, uniform, TRANSPARENT rules.  Until we have that, we're putty in their hands.  They win....we lose.

Rant over.



  1. My doctor recently prescribed an acne medication for my face, but my pharmacy pushed back to her because my insurance company only covered it for teenagers. I of course, decided that I didn't really care that much about my face - ha! But it was nice of the pharmacy (Rite Aid) to try to sort it out for me ahead of time...

  2. It's one of those things like oil and college and car insurance where they know they have you over the barrel so they make sure to screw you as much as they can get away with.

  3. I pay for insurance on myself, my wife, and my son. Apparently under my old employer plan I recieved a priority retiree rate. WHen I went to medicare and the insurence only covered my wife and my son, my rate went up 50%.

    I'm sure things will be greatly improved once President Obama's plan kicks in in full.

  4. My doctor gave me samples of a diabetes injection that did wonders lowering my blood sugar but when I tried to fill a prescription it wasn't covered on our plan (any plan) and it cost four hundred dollars per week. When I mentioned this to my doctor he shrugged and said he had no idea what it cost.

  5. Doctors will always prescribe what the pharmaceutical reps bring in as the latest and greatest and bestest, along with a ticket to Hawaii.

    They really don't know what it costs.

  6. That's ridiculous! They can't tell you what it will cost until after it's a done deal?

  7. Ah, yes...FORMULARY. Good grief.