Monday, October 01, 2012

Bound to Happen Sometime

Day 279: Off To BedI am so bad at the way our medical system works. There's so much information and no matter how much of it I read, after an unseemly amount of procrastination, I always miss something. I know it's designed for me to miss something but I'm still surprised every time.

I got lucky, really. The first time I got health insurance it was only major medical and I never busted anything badly enough to use it. Then I got something a little better but I was young and didn't really need any care and the premium was entirely paid by my employer so I just didn't use it and didn't worry about it and maybe had some flex spending money which I spent to get new glasses when I left the job. My next salt mine was in my chosen field and their health insurance policy was that if you got sick you should get well as soon as possible so you didn't miss any performances and if that involved going to a medical professional they would lend you money (up to $200). That's a pretty simple system, even I could understand it. It's a shitty system but it's simple. I did get sick. I didn't have to borrow money. I did get well. End of story.

By the time I got another job that offered health insurance I was old enough that I did need to use it occasionally. Again I got super lucky because every time I wondered how much I would have to pay for something someone who knew the system better than I would look it up real quick and say, "Nothing. You don't have to pay anything." I'm pretty sure that unless I'd had some sort of organ transplant I never would have paid anything. The job sucked my soul out through the gap underneath my right big toenail but the benefits were bangin'.

Day 281: Things I Am Ingesting I got so used to this easy, intelligent system that I convinced myself it was the norm. When I moved jobs I insisted that I get a similar insurance package and, after doing my own research, found the single comparable plan available to individuals living in New York State. It was expensive but I knew how bad I was at learning these systems so I got it approved and went with it. I wound up paying about a third of the premium cost in taxes each year but I could forget that was happening most of the time. The bill climbed and climbed and eventually skyrocketed a couple of years ago. My monthly premiums were more than the ones for a family of four on most other plans. My employers rightly wanted a change and I couldn't in good conscience drag my heels over it any longer.

So, with much wailing and rending of garments I did the research and I found a plan that would save us all a lot of money. I thought I knew exactly how much and I negotiated so that we were, I thought, all coming out ahead, even though I would have to do more work in terms of managing how I obtained care.

Remember what I said about all the reading?

Being sick for months at the beginning of this year I, for the first time, hit my deductible. I wouldn't probably have known it if a kindly doctor hadn't pointed it out. I may have clicked my heels a bit because, as far as I knew, the minute that happened I stopped paying for everything! It was the most interesting thing I learned in all my reading and what sold me on the plan.

Coming straight from the kindly doc's office I picked up a prescription and was asked to pay. I decided that was a technical glitch and I'd hear soon about my refund. (The powers of denial are strong in this one.) A couple of months later when my prescription ran out I refilled it and was asked to pay again. I'm not proud of how I reacted in the presence of a pharmacy technician who must get a lot of shitty reactions but I'm not exactly ashamed either. I grumbled my way home and did some reading and discovered the crucial code I had misinterpreted (or possibly simply blocked out as being too confusing). Once the deductible is paid all the doctor's visits do not have a co-pay but prescriptions are covered in a tier system. This means that, depending on what tier of medication is prescribed, the insurance plan will cover 20 or 40 or 60% of the cost.

Day 304: New Meds Meanwhile back at the ranch I'd been prescribed a lot of medications (pictured). The ones I was sure I didn't need were the ones for acid reflux. Personal scientific investigation has finally brought me around to the realization that yes, I do have acid reflux and it does impact my breathing. By this time, though, I'd made the doctor switch to a different medication that works on the problem from another angle. A couple of nights ago I ran out of that medication. I had to wait until I was at work today to call for a refill and it wasn't until then that I noticed that the doctor will have to be called before it can be filled. While I was standing in line listening to the pharmacist calling the doc (and leaving a message) I noticed a list of prices on the wall. I casually read through them finding both acid reflux meds. The first one I'd been prescribed, the one I'd finally come to understand worked better, retails at just under $118/30 pills. The one I was currently trying to get refilled retails at just under $30 for the same amount.

Which one do you think I'm going to request that he keep prescribing?

I'm not completely oblivious (just selectively). I know that people make these decisions all the time. Many people decide not to take medication at all because they simply can't pay the cost and don't even have the partial coverage that I do. I point this out both to say that it's utterly insane and wrong in general and to mark the milestone. Today our broken health care system was finally able to fuck me in this particular, special way.

I'm pretty sure no one makes a baby book for this.


  1. Oy. Also, I hear you. My insurance has a completely ridiculous deductible. Insane, in fact.

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