A Curious Statistical Anomaly

I’m sure out there somewhere is a nice blues jazz number with that this title, “Medical Insurance Blues”. However, it’s two days later and I’m still seeing red. Here’s the background. I have allergies — lots and lots of them. Basically, if you say I’m allergic to the world you’ve got it. I don’t even bother with the skin test anymore because the very last time I had one everything reacted so they tested for the base (no reaction) and for the needle invading the skin (no reaction). So, now I have them test my blood (RASP test). The doctors explain (patiently I might add) that the test is not sensitive enough and we should do the skin test. I counter with “Do the blood tests and if you need the skin test for some items, we’ll do those.” I’ve never been asked to retake a test because everything tests high enough.

Now for the problem. It’s pollen season in force big time down here in Maryland. My eyes have been itching like crazy and at times I wish I could do the cartoon thing of popping them out of my head and running water over them. So, I’ve been using the over the counter allergy drops and tears and anything else I could find. Finally, I gave up and saw the doctor. He gave me a prescription (hereafter Rx) for some eye drops. We dropped it off at the pharmacy but had to wait to pick it up the next day.

Go to pick it up and insurance has refused to pay for the Rx. Why, you might ask. Are you ready for this one. The insurance won’t pay because, get this, over the counter eye drops work just as well as the Rx ones. I just love the way an insurance clerk, whom I have never met, and who doesn’t have a medical degree, and who has never talked to my doctor, can make such judgments. Yes, statistically, for some people, maybe the over the counter drops work just as well. But to make this declaration without ever asking if I’d used over the counter drops is pure bottom-line bean counting.

Will I fight this? No. This is the third time they’ve done this. Insurance is Anthem BC/BS PPO — the plan is a good one and generally they’re okay but every now and then they come up with these gotchas. I fought for one drug and finally got them to pay for it but it took 5 months of fighting and faxing documents and getting papers signed and made out by the doctor. But I couldn’t afford the over $110/month to pay out of pocket for the drug. It was exhausting and depressing experience and in this case not worth the effort.

The doctor gave me a sample and I’ll use it sparingly until the season is over. The insurance covered it last year and maybe they’ll cover it again next year, but this year they decided to make me suffer. The thing is it would be easier to take in some ways IF the insurance company would at least acknowledge that they’re playing with my health. When they refused the sleeping pills about two years ago they said, and this is almost a direct quote from the manager of the telephone support.

We’re not making medical decisions and we’re not stopping you from getting the drug. You can get it anytime you want, you just have to pay the full price for it.

I just love the way they can distance themselves from the suffering they cause. What did I do about the sleeping pill. I decided to do without. It’s easier since I quit work and now work at home. Every now and then I just can’t sleep until after being awake for 36 to 48 hours.   I usually finally manage to sleep 8 hours and then I’m back to my normal 4-6 hours a night (if I’m lucky). Somedays, there just aren’t enough spoons within reach.

What I know is that I’m lucky. We have insurance through the company my husband works for, and many people don’t have any at all. I did find out that people with no insurance pay more for drugs than people with insurance. I’m not talking about the copay. If you pay attention to the sheets that come with your Rx, in some places they say the drug costs X and the insurance pays Y and your co-pay is Z. Then if insurance won’t pay, you usually pay the cost, X. However, if they make out the payment sheet thinking you don’t have insurance it’s usually X+some number B. So not having insurance costs even more for health care.

None of the present candidates have a decent health care plan. Mandatory health care unless the government is going to pay for it all isn’t going to do anything. If people can’t afford it now, they can’t afford it when it’s mandatory. Do govvies really think people don’t have it because they’d rather get a six pack? People don’t have health insurance because A) they have pre-existing conditions that run the cost through the roof or B) they’d rather feed their kids and keep a roof over their heads or C) they’ve got A and B. Let’s face it medical care should not be a profit making proposition.  I mean who came up with the brilliant idea to put the health of our citizens in the hands of someone whose business model makes money by NOT providing healthcare?  In America, we need free basic medical care for all citizens and clerks should not be denying things that a licensed doctor has prescribed for a patient. Why bother to license physicians if office clerks can over-rule them.

I feel better having let off steam. But I’m still outraged — and — my eyes still itch!