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.