Wednesday, October 13, 2010

(43-78) You Know You Have A Problem When...#9

You know you have a problem when you pay through the nose for your insurance; and then a doctor prescribes you a hundred dollar medication, that your insurance doesn't cover.
When I wrote "Just Another Day," I didn't mention that on our way to Chick-fil-A, my right eye became incredibly, itchy; and uncomfortable. I didn't omit this for any particular reason; I just didn't think that an irritating, itchy eye was worth mentioning at the time.
Well at 215am, Hershey had herself a little barkfest, so I got up to let her out, and noticed that I had some crust on the previously, itchy eye; and it wasn't just the kind the sandman leaves.  Thankfully, it wasn't goopy (sorry if this is TMI,) but nonetheless, I was concerned.  When I got up at 515, I inspected my eye, and although there was no discharge; it was still unusually, itchy and it didn't look the same as my other eye.
After I dropped the kids at school, I went to Urgent Care, fearing that I had Pink Eye.  I don't frequent Urgent Care as my co-pay is $75; but if it was Pink eye; I knew that it needed to be dealt with right away.   I arrived at urgent Care 10 minutes before they opened, but chose to sit in my car and update my date book.  When I saw 2 women waiting outside the door; I immediately joined them, and the Urgent Care door opened punctually.  The woman  ahead of me paid $3.50, and the woman following me (who had no insurance;) paid $99.  I was struck by the disparity, considering that I pay about $500 a month for insurance for my kids and I, and that's after my employer contribution.
I was amused when the nurse asked me how much I thought I weighed and what my height was; not that I wanted to step on the scale; in fact I'd dreaded it, but I couldn't figure out, why he was just taking my word instead of asking me to step on the scale that was located IN THE ROOM.
The doctor promptly came in to see me and he couldn't have been nicer.  But after checking me out; he advised me that it wasn't Pink eye that I had; but allergies.  Great!  $75 to find out that I have allergies,which I've been taking meds for ALL OF MY LIFE.  OK, sure; I was very relieved not to have Pink eye, trust me.  But there was definitely an annoyance factor, in finding out that the insatiable itch was being caused by allergies.

The doctor prescribed some eye drops; and advised that there were some over the counter products that could work as well.  I said "Maybe I should just get the over the counter drops;" to which he replied, "Well check with the pharmacist because the over the counter ones can be a bit pricey; like $10."
I went in to CVS and asked the pharmacy tech if she could tell me how much my prescription would be, before they filled it.  She asked me to wait a few minutes, then called me over and told me that my insurance didn't cover the eye drops, so it would be $103.95.  I was taken aback.  I asked why they didn't cover it, and pointed out that the prescription stated that substitutions were allowed; but she said their was no generic.  I was perplexed.  She told me that the pharmacist would be back in a minute, and I could speak with him to see what he suggested.  I greeted David (the pharmacist) as he walked past me.  He's my favorite pharmacist, and quite familiar with me and my family.  The tech explained the problem and he immediately came out and took me to the over the counter aisle, and gave me a $6 package of eye drops that he said should do the trick.  I asked if I should buy the artificial tears that the doctor had recommended, and David told me to save my money and just try the allergy eye drops for now.  On a positive note, I'll say;  I LOVE David!  And if you live in my area, then I highly recommend that you bring your prescriptions to the CVS at 83rd Avenue and Thunderbird.  But on the other hand, I have to ask "what the heck is wrong with this picture?"
For the life of me, I don't understand how I pay SO much for insurance, and pay an exorbitant amount for my Urgent Care co-pay; only to find out that the allergy, eye drops the doctor prescribed; are not covered by the insurance that I pay so much for.  In my perfect world, if the doctor that I'm paying so much to see, after what I've already paid to my insurance, thinks that I require a particular medication; then my insurance darn well better cover it; OR perhaps the doctor should have to make sure that a certain medication is covered on the patients plan; and provide an alternative if necessary.  I think that they get paid enough to do that.  To make sure that a patient is going to be able to get the medication that they prescribed at a somewhat reasonable price; but hey, that's just me.

Sometimes you just have to laugh.  I think that's a part of how you FLOW; because seriously, when you consider that this whole itchy eye thing, should have been added to my day full o mishaps from yesterday; it just keeps getting  more and more unbelievable.  Couple that with this insurance incident and I've got quite the week going.  Am I dismayed about the insurance infraction?  You betcha!  But unfortunately, there are some things that are beyond our control, and even though it stinks; there's absolutely nothing that I can do about it; so once again; I'm gonna FLOW.
Till next time...


Julie Tucker-Wolek said...

amen to this girl... we pay an INSANE amount in premiums and then our deductible a YEAR is $3600.00... drives me insane... if it wasn't for the fact that brookie needs surgeries every year... we soooooooooooo would just pay straight out of pocket... makes me soooooooooo sad at how much we pay! :(

Joni Parker said...

Ok...I agree with you....HATE INSURANCE... and I work FOR a Health Insurance company .. probably worse for me since I can see it from the inside. I have terrible insurance, high premiums & a high deductible!! The only thing I can recommend is that you call the insurance YOURSELF and check into the RX to see if/why not covered and if they have any suggestions. You'll probably want to talk to the person called "Pharmacy Benefit Manager" or some other similar title. I've seen RX's reject and the Pharmacy tells the person it's not covered, when there was some glitch or something else that could've been done and then the RX would have been covered....