Tuesday, September 27, 2011

Shoot Me Now (singing the health insurance idiocy blues)

Me? I am not by nature a brawler, a fight-picker; someone fond of my own angry self. I'm a conciliator, a peacekeeper. I really dislike confrontation, have been accused of avoiding it by sidling away, like a smiling crab doing the side-step.

But somehow, as I sit down to write a lovely "just write" post tonight? I can't do it. I have no lyrical in me. I find myself steaming and gunning the throttle. Again.

Maybe I need to start a theme day...  Cranky Rant Tuesdays.

My tag line? "Come visit my blog on Tuesdays when you want to feel better about YOUR life by reading about all that's gone pear shaped in MINE!"

Think it will catch on? Hmmm.

So, you may be asking yourself (those who aren't backing away slowly, that is)... What has my knickers all in a bunch? My panties in a twist? My... well, you get the picture....

Health Insurance idiocy. Also Big Pharma greed. And Chain Pharmacy stupidity and incompetence.

OK, now it's time for my Canadian/English/Irish/Australian/Norwegian/etc.etc. friends and readers to snicker and gloat. Yes, all of you who live in those godforsakencommunist countries that have - GASP! - socialized medicine.... go ahead, I'll wait.

OK, done now? Good, let's get on with it.

First the set up: My son Jacob takes a number of psychoactive medications. He's on a "cocktail."  Sounds fancy, but it's not. He's just... complicated in his neuro-biological differences. And so the help needs to be complex, too. Really.

And with a very intelligent intelligence at the wheel, prescribing and tinkering. We (very luckily) have that.

And the 3 different medications he's currently on (very low doses, all, don't worry)? Are keeping him rolling along beautifully right now. Calm, happy; NOT riddled with anxiety and gnashing his teeth; NOT crumpling into a sodden weepy heap over a dropped pencil. And also WITH increased concentration and attention; able to really listen and learn better than ever. (Spitting over left shoulder 3 times and warding off the evil eye.)

So, we recently needed to change health insurance policies (due to an expiring COBRA situation). My husband and I are both freelance / self-employed. We pay for our insurance ourselves. You can see where I'm going here, yes? There really are only lousy overpriced policies available for people like us. And we picked the best of that bad bunch. But still...

We are now in the situation where the medicines that Jacob has been prescribed and HAS BEEN TAKING, the ones that are demonstrably working for him, are needing to be "pre-approved" by the insurance company.

Yeah, that's as much fun as that sounds.

And the approval process? So NOT what was described to me by the pharmacist: "Have your doctor call this number and explain why it needs to be, and they'll approve the medication." As if.

When the doctor called me back after my frantic message, I could hear the stress, the weariness in his voice. He told me that it's not just "a phone call" that's required, but rather it's TEN phone calls. And being transferred from department to department, and being put on hold, and hung up on. And then calling back, and being transferred again.

"They make it hard on us doctors on PURPOSE, to discourage us from prescribing certain medications -- the newer, still patented ones. They think we'll give up and pick something older and cheaper -- even if it's inappropriate for the patient -- just to avoid the hassle and time drain. It's harassment and coercion, pure and simple."

And then this time it wasn't just a conversation, but FIVE full pages of paperwork he had to fill out - questionnaires and ESSAYS to write to justify giving this medication over others which are in the same CATEGORY as the one the doctor had prescribed but are truly DIFFERENT medicines.

Because a bunch of accountants' opinions about what medicines my autistic son needs to be taking count SO MUCH more than those of his highly regarded pediatric psycho-pharmacologist who has been practicing for a bazillion years and regularly lunches with and picks the brains of the guys who literally WROTE THE BOOKS on most childhood psychiatric & developmental issues and are at the forefront of all the cutting edge research.

(Sorry, I shout a lot in ALL CAPS when I'm truly peeved. And I'm truly peeved, in case you hadn't noticed.)

This was all today.

Yesterday it was me showing up the local D-R pharmacy counter at 6:15 to pick up a medication we had run out of, that Jake needed THAT NIGHT to find a long line of unhappy people, EVERY ONE having trouble with their prescriptions being filled properly.

And I was only AT the motherfucking D-R because they (and other big chains like them) had effectively closed down all the small family run pharmacies in the nearby neighborhood where the pharmacist KNOWS you and gives a rat's ass about your family.

Now, being all sensible-like, I had called at 5 PM and spoken with the pharmacist there to make SURE they had gotten the script called in and that I could pick it up right away. I was told yes, definitely in. He had me hold on while he checked to make sure it was in stock (it was), told me they were busy and to come for it after 6. Took Jake's birth date info.

But when  I get to the front of the line? No filled bottle waiting for me, no prescription sitting in the in-box waiting to be filled. Seemingly no record of it being called in at all. Questions of my sanity ensued... am I CERTAIN it was THIS D-R and not the one up the road? YES!

And not only had they no record of my doctor calling in the prescription, but they had no record of my son Jacob in their computer. Which is quite odd since we've been having prescriptions filled there since the boys were BORN, 9 years ago.

Oh, what was that? Since they merged with another Pharmacy Giant and put in a new computer system a few weeks ago it WIPED OUT all their patient and medication data and now EVERY patient is considered a new patient and they have no history on anyone. Nice going, guys. Well done!

Would I please step aside and wait while they try to find Jimmy Hoffa my son's prescription.

Finally the pharmacist that had taken my call and gone off shift at 5:30 returned the page and straightened it out... the prescription (unfilled) was sitting on the back counter, face DOWN. Because it couldn't be entered into the computer, because they didn't have Jake's info in the computer, because he's a "new patient."  Riiiight.

So it's going to take ANOTHER HALF HOUR to get him into the computer and get the prescription filled. And can I stand over there with the growing crowd of fuming customers to wait, please.

And then? After that fun-filled 1/2 hour?

THAT'S when I find out that it's not automatically covered on our new, stinky plan. That it needs to be "pre-approved" with a call from my now-closed doctor's office to the insurance company's bean counting gate-keepers. 

Or? I can pay retail... $266.


And do you know? It's really not a new medication at all. It's a new formulation of an OLD one that has been around for years. But someone figured out how to make a really good time release delivery method for it. So THAT'S the part that's patented. That's why it's so much $$.

And if my son is going to take this medication, he really needs a steady supply in his blood stream, I really can't give him 6 pills a day at four hour intervals, waking him up in the middle of the night for meds now, can I?

So, yes, he NEEDS this expensive time release formulation. Which is THIS expensive because... they think can get away with it.


My son needs his evening and morning dose.

I get them to break up the prescription and sell me 2 pills at retail.

I go home, crisis averted.

And yes, I may have exploded a few times in the drug store. Especially when they pretty much accused me of hallucinating the 5 pm conversation with their other pharmacist.

And, yes, some of this is my own damn fault for waiting until the very last minute to get the refill, turning something that should have been an annoyance into a crisis. That's ADD's calling card there, folks.

And did I mention that during all of this the kids were being watched by the upstairs neighbors, because Jake was still finishing his dinner and they really didn't want to come out to the store with me, and I was only going to be gone 15 minutes?

Yeah. I owe them. Big time.

OK, rant essentially over. Jets cooling now....

And that concludes today's edition of Cranky Rant Tuesdays at The Squashed Bologna.

Tune in next week folks, to hear all about the "check engine light" in our 1997 Toyota that just won't stay off.

(Don't you just wish you were me, now?)

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