Having multiple sclerosis and applying for individual insurance coverage is enough stress to send a person right over the edge! Ironically, the first thing a doctor will tell you upon diagnosis is that you should limit stress in your life. Just one of life’s really bad jokes.
A little background: My COBRA period ended on January 31. Months of trying to get accepted, attempting to get quotes, etc. ended with us taking a fairly horrible health insurance policy. One which we took great pains to understand completely.
So here’s how it breaks out:
$520 per month (at least for now) for insurance premiums
40% copay on prescriptions
$5,000 medical deductible + $5,000 prescription deductible + $10,000 specialty drug deductible
specialty drug max out-of pocket = $500 per script
Not a pretty picture to begin with, but it is what it is.
Naturally, the insurance change required a pharmacy change. This involved:
Calling insurance company to confirm $500 max out-of-pocket per month
Getting pharmacy one to fax prescription to pharmacy two
Calling pharmacy two to see if mission accomplished
In addition, they need the doctor to call and confirm
Call doctor and wait for response
Doctor calls pharmacy to confirm
Call pharmacy to arrange shipment
Pharmacy is ready to ship but insists on 40%, considerably more than $500
Already several weeks into this process, I must start back at square one, the insurance company. I finally cut through the voice mail/hold system, which I suspect is the ninth circle of hell. The highly enlightened person on the other end of the phone tells me that the “out-of-pocket” expense of $500.00 listed in my recently received “welcome” packet, refers to the insurance company’s pocket, not mine. No amount of logic could convince her otherwise. No supervisor to disagree with her.
The same well-informed woman tells me that really should speak to my doctor — because if he would simply write me a prescription for a generic, I wouldn’t have this problem in the first place.
Hmmmm…….wasn’t she helpful? If you are reading this and do not have knowledge of multiple sclerosis medications, the average cost is $1,700 per month. There is NO generic. I don’t know what planet she was originally from, but “out-of-pocket” has always meant the patient’s pocket. I wonder how big a bonus she gets if she aggravates the patients enough to make them go away.
Well, hubby had lost all patience by then. He got in on the fight. Back and forth we went until finally, tomorrow, I will receive my first shipment from my new pharmacy at $500 per month, as stated in my “welcome” packet. And it only took one month, dozens of phone calls, a bit of high blood pressure, and some of that wonderful stress I’m supposed to avoid. We narrowly escaped the ‘ol “bait and switch” routine.
Oh, yeah. They hinted that I may have this problem next month, too. Ahhh…something to look forward to. You see, they had to perform an “override” in the system and have yet to permanently correct the problem. So sorry and all that.
Such is life with chronic illness.
On a final note, it’s hard to get too excited about our victory. Afterall, how long can a middle class family carry such a load?