Friday, September 24, 2010

We've Got to Do Better Than This

Y'all might have heard me Twhining (whining on Twitter) about my nasty cold this week. Here's the rest of the story. It's, okay, a little self-indulgent, but stay with me. There's a point.

I have weird sinuses. A deviated septum and a hollow flat bone that's not supposed to be hollow or flat combine to make my sinuses drain poorly, or so says the ENT guy who did the CAT scan on them a few years back. (I know, TMI, right?) Because I also have chronic allergies, he wanted to perform surgery to correct the problem.

Oh nay nay. I don't believe in elective surgery. Even when it's not elective, those release forms you have to sign give me pause. After some trial and error, the ENT and I came up with a routine to manage my sinus woes. An important piece of this is a steroid spray, Nasacort AQ. I've tried other brands. For whatever reason, they don’t work for me. It's like squirting water up my nose, except they also give me a headache. For years, my primary care physician has been renewing my Nasacort AQ prescription.

Then, (as I understand it) because our current insurance company was going to raise premiums a substantial amount, Sugar's employer changed insurance providers from Insurance Company A to Insurance Company BCBS. This was August 1st.

On August 12, I went to get my Nasacort AQ refilled, and the pharmacy clerk at Walgreens told me that BCBS would not pay for it unless the doctor’s office filled out a pre-authorization form. (Excuse me, but when did writing a prescription stop being enough authorization from a doctor to give me medication? Used to, you only had to get pre-authorization for surgery.) She said she'd fax it to the doctor right then, but it might take a few days, did I want to pay the full amount for the prescription?

I was completely out, and knew from experience that letting the medication lapse during ragweed season was NOT a good idea, so I said okay. I nearly choked when she handed me the slip to sign. ONE HUNDRED AND THIRTY-EIGHT DOLLARS AND NINETY-NINE CENTS for a bottle of nasal spray. WTF?

But I paid it, because I needed it, and I thought SURELY by the time I went back to get my next refill, this would all be straightened out. Oh nay, nay.

A week or so later I got a call from my doctor's nurse. "Dr. (Redacted) would like you to try Flonase because your insurance company won’t pay for the Nasacort AQ." I asked her to please look at my chart and she would see that I had already tried Flonase and every other nasal steroid manufactured in our galaxy. She looked. She saw. She said she'd call me back. She didn't.

A week goes by, and I call the insurance company. They haven't received the faxed form from the doctor, but they'll be glad to fax another. I called the doctors office. They're having trouble getting Insurance Company A to pay for it...

I explained (without losing my temper) that I was no longer with Insurance Company A, but with BCBS. Okay, the nurse said, she'd try them. I never heard anything else from her, but I figured the SNAFU had been identified and corrected.

Oh nay nay.

When I went to pick up my prescription at Walgreens on September 12, the pharmacy clerk informed me that BCBS was still declining to pay for the Nasacort AQ, but did I want to pay full price?

Ha! I fell for that last month, thought I. I will call and straighten this out in the morning. So I did not get my prescription, even though we are still in ragweed season. I was living dangerously, but figured I could get this worked out quickly. Oh. Nay. Nay.

I spent the next week going back and forth between the doctor's office and the insurance company, who are apparently plagued by sunspot interference on faxes that travel between the two places. Both report having no trouble sending or receiving faxes with anyone else.

Then, last Saturday, we went to my sister's house for a cookout. Someone there was a carrier for a cold virus. I'm not pointing fingers, but my niece had a runny nose, and my brother complained of "allergies." All I know is that Sugar and I both came down with heinous colds in less than 24 hours.

Monday morning at 5 a.m., poor Sugar had to get on a plane, regardless. I stayed home and by Monday afternoon, I was feeling good enough to go to Jazzercise. Big mistake. By Tuesday morning, I was much sicker than I had been to begin with. There was a perfect storm in my sinuses. Ragweed, cold, no Nasacort AQ.

By this morning (Friday) I had green gunk in my head and my chest, and I was coughing so much my throat felt like it had been carved up with razor blades.

I called the insurance company yet again this morning, but they were having system problems, and the recording advised me to call back after 11a.m.

I called the doctors office and made an appointment ($35 co-pay). He must have thought I looked and sounded rough, because the antibiotic prescription he gave me ($60 co-pay) is, according to the leaflet written in 3 point font that they give you with all drugs now, ALSO USED TO TREAT ANTHRAX. I am not making that up.

When I explained my Nasacort situation, he regaled me with stories of having received faxes from insurance companies at 3:15 a.m., with a refusal to pay coming in at 3:30 a.m. because forms had not been submitted in a timely manner. I do not doubt him.

As I left the doctor's office, on the way to Walgreens to pick up my prescription, I called BCBS back. Their system was up. And no, they had not received the fax from the doctor on the Nasacort. I called the doctor's office back. The clerk said, "Wait a minute, you were just here? Why didn't you talk to the doctor about it?" I explained. (I did not yell at her.) She told me to come on back by and talk to the nurse. When I finished at Walgreens, I did just that.

My regular doctor (not the guy on call today who I'd seen earlier) came out, apologized, said the form was on her desk. They'd just gotten it two days ago, she said. Today, they faxed it back.

But, no one at BCBS can confirm receipt due to the volume of faxes they receive. I had the Nasacort filled. I paid the $138.99. Again.


What about all the poor souls who have prescriptions for life-threatening illnesses who have to go through all this crap? The ones who can't afford to pay exorbitant amounts for their medications? The antibiotic, by the way, would have been $193 had I not had insurance. I asked.

What about the ones with cardiovascular conditions who would have had a stroke from the stress?

I'm sorry, but WE HAVE GOT TO DO BETTER THAN THIS. For the love of sunshine and blue skies, we've got smart people in this country. Some of them are doctors and insurance executives. Some work for pharmaceutical companies. Heck, some of them are even in the government. Surely, someone can figure out a better way.

I know legislation has been passed. I still don't know what's in it. Does anyone? I'm not saying it's good or bad. I'm saying I don't have a clue what the impact to me or anyone else will be or when we can expect to see it, and I'm not sure anyone else knows either.

Here's what I do know. If memory serves, Sugar's company pays his portion of the insurance and part of mine as well. But the part we pay ourselves (however it's divided) went from $412 per month to $465 per month when we changed to BCBS, but that was less of an increase than if we'd stayed with Insurance Company A. Our co-pays also went up.

So far, the only change I can see that was caused by the recent legislation is that beginning January 1, we will have to have a prescription for over the counter drugs if we want to use our health savings account to pay for them. And we can no longer use the Visa card attached to our health savings account, even if we get a prescription for aspirin, cough syrup, or Alka-Seltzer. I will have to fax receipts to the HSA manager and wait for reimbursement from our own account.

More paperwork for my doctor, more paperwork for me, and more paperwork for the folks that manage our health savings account. But so far, nothing is cheaper.

Is this really the best we can do? Really?! I hope like hell it's not.

Peace, out....



Rebel Fan said...

It's SC. I haven't been able to get my celebrex authorized in almost a year. I've been popping generic advil like peanuts. Look at me cross-eyed and I bruise. A friend in NC who has the same job I do gets her celebrex for 3 bucks a month, no pre-authorization. And come January, I can't even use my med-reimburse card for the advil. WTF is right. -carol

Bob Strother said...

I say. "Throw the rascals out!" No, wait...that's Tea Party, isn't it? Never mind.

Brenda McClain said...

Susan, you nailed it, Girl!

Susan M. Boyer said...

Believe it or not, BCBS JUST called me and asked that I take a customer service survey over the phone. That was fun.

vicki strother said...

I think I developed an ulcer reading your blog. OMG!!! The doctors, the prescription drugs, the insurance!!!
Takes my mind off the possibility of terrorists accessing dirty bomb/nuclear capabilities.

Susan M. Boyer said...

Vicki, all I can say is it's a good thing there's a generic for Valium, and it's cheap. :)

Valerie said...

Oh. Lord, you've been through it, girl! Yes, we must fix the health insurance costs, paperwork jungle, mess. When I went through chemo, the insurance company denied a claim for a round of chemo because I hadn't gotten proper referrals for all the doctor visits. I was going to the chemo doctor three times a week--was I supposed to drive 20 miles out of my way to my primary physician each time to pick up more referrals? I finally told her, "It's not like I woke up one day and said, 'Hey, I think I'll go see a chemo specialist and have her inject me with thousands of dollars of toxic chemicals!' It was a course of treatment!" She finally relented. Thank God!

I've always been blessed with medical insurance. I'm so sorry for those who don't have it. Can't imagine how they afford even a simple illness.

Laurie said...

What an ordeal! That's just crazy. How long each year do you have to suffer through the allergies and nasal spray? I feel bad for you.

Susan M. Boyer said...

Thanks, Laurie! Unfortunately, I'm allergic to a long list of airborne things. Ragweed is the worst, but I use the nasal spray year-round. I'm grateful to have it. Before I started using it, I kept a sinus infection.

I really need to post something unrelated to mucus... :)