My Health Insurance Rant - TODAY!

[Bill Mattocks]

As some of you know, I'm prone to MRSA. Got it again; a nice big gaping hole on my chest. Just got back from the doctor's office.

He prescribed some antibiotic pills and some cream to put on the wound - something called MUPIROCIN ointment 2%. I dropped both scripts off at the drug store.

Got an email from the drug store; the insurance company won't cover it. Told me to call the insurance company.

I called. They said they only handle my health insurance, not the prescription. Transferred me. The company they transferred me to said that they only handle the reimbursement part, they needed me to call the company they 'partner' with to provide the administrative functions. The third company told me that my pharmacy insurance only covers the cost of a 31-day supply of the ointment; the tube is a 32-day supply. The company that makes MUPIROCIN 2% doesn't make a smaller tube. So they won't cover it. But it's not up to them, they are just enforcing the rules that the company that provides my pharmacy benefits provides them with.

So I call the pharmacy company up again. Nope, nothing doing. They suggested some other medications - which are NOT EFFECTIVE on staph bacteria. Uh, duh, what good would that do? Nothing, but at least it would be covered.

Then they suggested I call my doctor and have him prescribe a 90-day supply - they WILL cover a 90-day supply, but only if it is filled by mail order - so not only would I get way more than I needed, I would get it via slow boat US Postal service and not today. And I have a large and rapidly enlarging hole in my chest. Today. NOW.

I don't have the several hundred dollars this prescription costs. Payday isn't until Friday. I'm about to crawl through the phone and strangle these idiots.

And in the meantime, my employer tells me that my annual health insurance enrollment period starts today. Guess who won't be getting my business? These ***-hats, that's who.

The problem is, I'll most likely be getting a different set of ***-hats that behave precisely the same way. Nothing changes. I pay my money, I get the shaft. HCR fixed a lot for me, huh?

OK, end of rant. I'm just mad and my chest hurts. Another day in paradise.

 

[Stac3y]

Call your doctor. S/he can most likely give you a sample tube that you can use until the 90 day supply arrives. I'm really sorry you're going through this, and I hope you recover quickly.

 

[Bill Mattocks]

Call your doctor. S/he can most likely give you a sample tube that you can use until the 90 day supply arrives. I'm really sorry you're going through this, and I hope you recover quickly.

My insurance company suggested that as well. The doctor said no, they didn't have a sample tube for me to have. They said the insurance company called them about approving a 90-day supply and the doctor refused to extend the prescription; said I don't need a 90-day supply and that overuse of the ointment is what is causing MRSA-resistance to emerge, so they just don't prescribe more than is needed.

So my options at the moment include waiting until I get paid and buying it myself or going without. Either way, it may not get better by itself. MRSA does not clear up on its own, and it kills people. If it gets bad, I will take myself to the hospital and demand treatment.

 

[Carol]

So instead of paying for a 32 day supply that costs several hundred dollars, you'll be heading to the ER which will cost several hundred more dollars on top of that.

If you are so inclined...talk to your HR department. Unnecessary hospital visits affect their rates as well. They may be able to pull strings.

 

[Bill Mattocks]

Problem resolved - some hocus-pocus was involved, but friendly forces intervened and the insurance company was made to see the light. I still hate them, though.

 

[girlbug2]

It's good to know that the insurance companies can be prevailed against. I just wish I knew your magic secret Bill.

 

[Steve]

MRSA is no joke. I've have a few staph infections (not MRSA) and they were bad. Hole in my arm a few years ago, and then recently on my elbow.

Take care. Insurance companies are awful, but until we go single payer health care we sleep in the bed we've made.

 

[Bill Mattocks]

It's good to know that the insurance companies can be prevailed against. I just wish I knew your magic secret Bill.

The pharmacy did something that I won't go into, but it caused my prescription to be approved. Suffice to say that the insurance company still says it isn't approved.

 

[Bruno@MT]

I called. They said they only handle my health insurance, not the prescription. Transferred me. The company they transferred me to said that they only handle the reimbursement part, they needed me to call the company they 'partner' with to provide the administrative functions. The third company told me that my pharmacy insurance only covers the cost of a 31-day supply of the ointment; the tube is a 32-day supply. The company that makes MUPIROCIN 2% doesn't make a smaller tube. So they won't cover it. But it's not up to them, they are just enforcing the rules that the company that provides my pharmacy benefits provides them with.

That right there.
That is the reason US health care is so expensive. All these companies need to turn increasing quarterly profits. And they can increase their profit by denying coverage. This leaves you in the mud twice. Once for jacking up the prices, and once for shafting you when you need them.

Anyway this is not the place for that can of worms.
Good luck with finding a solution.

 

[WC_lun]

Bill, I can definitley sympathize with you. I've found myself in the hospital a couple of times because of BS like this. For the most part HCR hasn't taken effect yet, but the insurance companies are going out of thier way to hike prices and increase thier bottom line, even though the HCR will bring more money into thier bussiness. I think maybe if government is serious about regulation, it should turn its' eye toward the shell game health insurance has become.

 

[Master Dan]

Bill don't play with this MRSA if it gets below the blood flow will go flesh eating and can only be controlled by agressive IV antibiotics in the ER or hospital which could kill you fast if not treated.

Based on insurance get what they will pay for and ask the doctor and pharmacy/hospital or clinics if they have any samples many times you can get by with free meds untill the scrpt comes in?

Health insurance is a mofia that provides nothing they mark up health care 30% and try to increase profits by deniing any way they can.

I wanted Obama to not be an Uncle Tom and force singel payer because no more insurance companies its non profit the government pays direct.

They say some good things are comming I hope so?? but corporations are not going to give up with out a fight.

We bought AFLAC paid for the last four years they tell everybody they cover the 20% plus personal expenses due to large medical bills my wife and I had the first side by side Gall Bladder Surgery ever done I was supposed to be her escort and wound up worse than her. In Alaska it is very expensive including travel our left over bill after 80% coverage not counting travel and other expenses was $8,000 Aflac paid her $600 and me $900 and it was 90 days of the worst double speak paper work I have ever seen. Here we say eat the duck kill the duck.
Hope you get better.

 

[Bill Mattocks]

All, thanks for the concern; I do have the stuff now. It took some manipulation by the pharmacy to get the insurance to 'approve it'. They still insist that it is not covered because it's a 32-day supply and not a 31-day supply. They allowed me to file an appeal, but they called me last night and told me it could still take up to 48 hours to get approved, even if it could be approved. In the meantime, they suggested I just buy it myself. Which was my original complaint - I did not have the money to 'buy it myself'. Yeah, lots of help, insurance company. Thanks for that.

I did check with the doctor's office, they have no free samples to give. But again, I do have the stuff now, thanks to a sneaky pharmacy person, whom I thanked.

 

[Emma]

Stories like this make me glad I live in Australia with our health care system!

It's good that you got your meds Bill, even if someone had to do a dodgy.