Thursday, October 29, 2009

Breaking Free - My Only Option?

Those of you who frequent my blog, know that I sometimes blog about health care/insurance and that I'm a hard-core progressive when it comes to Universal Health Care. Don't bother trying to scare me with the concept of 'government run' health insurance because that doesn't scare me one bit. I want to live in a healthy and intelligent society. I believe in single payer health care and public schools. But as of Nov. 1, 2009, I will be uninsured and more or less uninsurable. In this last week, I'll spend about $500 on all of the co-pays for the meds I need. Most will last me just 3 months. Some I've been filling and stock-piling in anticipation of this.

But on Nov. 1, I will be freed from Blue Cross Blue Shield, COBRA, and in many ways from 20 years of my life that I've spent trying to dance, stand on my head, and otherwise survive through the restrictions my insurer put on the amount of say, Imitrex, I was allotted each month. I'm a rock star at my pharmacy--one whose tour is ending. I've given a lot of thought to how I feel about being uninsured, and I have to admit, there's something liberating about it. I'm not interested in paying premiums to a soul-less entity anymore. I care about myself much more than they ever did.

During the health care debate in this country, there's a lot of chatter about the public option, about how to pay for it (which is doesn't matter; you pay for it nor matter what), and whether or not there are real savings to be had to health care reform by stopping fraud, waste, and abuse. There is. Here's an example that happened to be about a month ago:

My doctor was concerned about my blood pressure and in addition to meds, wanted me to get a BP cuff for my home so I could take regular readings. I called BCBS and asked them if this was a covered item. "Yes," they said. "100%?" I asked. "Yes," they said. My doctor wrote me a prescription for one, I took it to the pharmacy and they said it wouldn't go through. I called BCBS back. "I don't understand. You guys said this was covered." "It is," they said, "But only if you get it through your doctor." "My doctor doesn't sell medical equipment," I said. "Well, in that case, here's a list of vendors that will give you 40% off," they suggested. "So, let me get this straight," I said, "A BP cuff is covered in full only if sold to me by my doctor's office. Otherwise, the best I can do is get 40% off?" "Correct," they said, "That's your plan." "Fine," I said, "I'll call an approved vendor. I did that and found out that their prices were marked up so high, that I would be paying twice as much for a BP cuff from them than if I just paid retail for the damn thing at CVS. We're talking $75 vs. $182. I called my doctor's office to let them know. The nurse said there was nothing she could do.

A month or so later I was back at the doctor for a follow-up, and when my doctor finally made it to my room, she was clearly upset. Upon inquiry, she told me that she's just spent an hour on the phone with BCBS because one of her patient's needs a nebulizer now. She then learned that she could get it covered for her patient if only she sold nebulizers at her office. "Why would I want to do that?" she asked, "I'm a doctor, not a med supply house." She went round and round with them about the idiotic rule, hung up on the phone, and announced to the office that they would now be selling nebulizers. "You need to sell BP cuffs, too," I said. I'm in the same situation. My doctor wasn't done with her tirade, "I just went off on them because--get this--I can buy BP cuffs for $72, but they're going to reimburse me for $185 for everyone I sell! That's ridiculous. They want me to defraud them. I'll get double the price if we sell equipment out of the office. I'll make money. I've never heard of something so assanine. Why would they do this? This is why premiums go up and up and up. Unbelievable."

I nodded and smiled, "Yep, just think of all the money you'll make with this deal. Might as well open a side store for med equipment. You'll make a killing."

She opened up the door to my exam room and bellowed into the hallway, "We're now going to sell BP cuffs, too! Stock up!" and shut the door.

So, if you think there isn't real, concrete savings to be had in reforming rules that, think again. And I have a message for every health insurer that rejects the public option because it makes their gravy-train, anti-trust hold on the industry a wee bit less profitable: I'll make a deal with you. You kill the public option, and I'll kill every single drug commercial I see and every print ad in a magazine. If you're not interested in serving the public, then I don't think you should be allowed to advertise to us. I don't need to know what diseases are awaiting me when I won't be able to afford the remedy. I'll live with my impending Osteoporosis, PAD, Restless Leg Syndrome, depression, diabetes, and erectile dysfunction. Ignorance is bliss, right?

Boy, is it ever.

Ignorance... my simple win.


Artwork is Comfortably Numb by The Little Fox on Etsy.
Read all of my health care/health insurance posts.

1 comment:

  1. You said it! I agree with you 100%. I maybe in a similar situation. My husband's in a little denial about my becoming uninsurable ... we're on COBRA long meds with no insurance will be over $1000.00 per month! No one would want to be on these things...I, like you need them. It is insane the way our medical is run in this country. People die every day because they can't afford their meds.. My mom would be blind if she couldn't afford her meds...sorry for the long comment. But, insurance companies piss me off to no end!