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The Health Insurance Safety Net TodayBy Kim Hudson Have you ever felt like you've slipped through a crack in the safety net of our society? Just last week I found myself in such a place and I wanted to share a little bit of my expedition to find a solution to a potentially life-threatening problem with you. First of all, it's important for you to know that I have health issues related to my disability that require me to take several very expensive medications to be able to eat and live without excruciating pain. Like countless other Americans I depend on my health insurance medication coverage to make these life-sustaining drugs affordable for me. Last Tuesday I called my local pharmacy to refill a prescription for Aciphex, a medication I take daily to control my acid reflux disease. I usually pay the $30.00 co-pay for refills of this prescription. The pharmacist informed me that for some reason my insurance was no longer covering this medication so I would now have to pay $735 to refill my prescription each month. I was astonished by this answer and asked her why the insurance was no longer covering this medication. She said she had no idea and that I would have to call my insurance company to find out more information. I called my insurance company and after waiting on hold for over 45 minutes a customer service representative told me that I had reached the maximum prescription drug benefit listed under my policy, and that I would now have to pay full price for all of my medications. I was outraged! I asked the customer service representative why I had not been informed that I was approaching the maximum amount allowable under my plan prior to exceeding it. She said that it was not the responsibility of the insurance company to inform people about the parameters of their insurance coverage. I asked her, “If it's not your responsibility whose responsibility is it?” She did not answer my question and just advised me to talk to my employer about the limitations of my health insurance plan. I explained to the customer service representative that I was on disability and that this health insurance was provided under COBRA. I told her that I only received $772 in monthly disability payments, and with a hint of sarcasm I asked her how she proposed that I pay for one medication that cost almost the same as my monthly income. She said she was sorry but she had no other suggestion for me than to contact my former employer for assistance. I wondered to myself how many times I would be passed around before I actually got a viable solution to my problem. During round three of my marathon phone odyssey I called my former employer who said that my only option was to get a hold of the insurance brokerage firm that handled my insurance policy itself. The insurance broker in turn said he was sorry because he didn't think that there was a prescription drug maximum under the PPO plan that I was currently a part of. His only advice was to contact my doctor directly and ask for two weeks worth of samples of Aciphex while he looked into any other insurance plan options for me. Since it was Tuesday of Thanksgiving week I was pretty certain that I was not going to be able to contact my doctor directly before the holiday. However, I phoned his office just in case my call landed in the hands of a compassionate receptionist or nurse. Sometimes the nurses have as much power to take action as the doctors do. My hunch was right, my doctor was out of the office that day and the nurse said it would be difficult to reach him before the Thanksgiving break. My mind began to race with fantasies of storming his office and demanding all the drug samples they had. After all, who could deny me the medicine I needed to be able to eat my Thanksgiving dinner. Fortunately, I didn't have to put on my Rambo costume. The nurse at my doctor's office promptly called me back and said that there would be a two-week supply of Aciphex waiting at the front desk for me. I breathed a sigh of relief knowing that I had a two-week reprieve to figure out how in the world I was going to pay for this and all my other medications. Meanwhile, my insurance broker contacted me and said that since it was an open enrollment time I could conceivably enroll in a different PPO plan that would cover the majority of my medication costs for the next 12 months. The process of resolving this insurance issue was grueling even though I have had several years of experience as an advocate. I can only imagine how confusing and frustrating it would be for someone who is not accustomed to navigating this maze. It is unacceptable that any of us should have to struggle through the labyrinth of our health care system. ***** Kim Hudson has over 15 years experience working as a social worker with people with disabilities. She spent many years as a benefits specialist and a political activist within the community. She has extensive experience working with and teaching people about adaptive technology. PLEASE NOTE: PORTIONS OF THIS WEB SITE ARE UNDER CONSTRUCTION! |
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Copyright © 2007 by ILCHV |
