Insurance Rant

You just can't win in this country when it comes to medical coverage!

*sigh*

But I'll just try to limit my rant to what happened to me today. I have been on a medicine for the past two months. It's called Entocort, and it's super expensive: we have been paying a $50 co-pay each month, and our receipt from Walgreen's says my insurance (BCBS) saved me $1,186.79 for ONE month!!! That's INSANE!

I was first put on this medicine for two months back in January along with another, and, when we got the first month's prescriptions filled, our insurance saved us somewhere over $4,000 (yes, THOUSAND) dollars. (Don't you find this utterly ridiculous? I know insurance companies are theoretically able to write off these costs because of the premiums we pay into the company...but I just find this system to be so unfair for someone who can't afford these insanely high insurance premiums and deductibles in the first place, much less a medicine or treatment without insurance.)

Anyway, once I finished up those two months, I went on a different (and cheaper) maintenance medicine of which I discovered I was allergic after breaking out in hives and getting terrible achy knees...all the while my usual stomach symptoms worsening. (I have Crohn's disease.) So I went back on the Entocort to get things under control.

For two months, I have been taking three pills a day. For each prescription each month, we pay $50, so, thus far, we have paid $100. The third month (starting tomorrow), I am supposed to start taking just two pills a day, and then one pill a day during the fourth month to wean myself off of this medicine (since it's a steroid) without the need for any maintenance meds afterward. We assumed this meant our co-pay would consequently go down each month--or, rather, it would equal $50 for both months--as I was continuing to take the same quantity of pills over twice as much time. (You know what they say about someone who assumes anything...)

I tried to call in my refill yesterday, but the bottle informed me, "No refills--doctor authorization required." Huh? Say what? When I was issued my prescription and went to fill it the first month, I clearly remember that each month's dosage was spelled out on the prescription form. Rather than calling the pharmacy and ending up in another tangled web, I went directly to the source to get it straightened out. Thankfully my doctor's nurse is AMAZING (even if their billing office is not) and agreed the prescription had each month's quantity listed; she notified me this morning she was calling in the remaining prescription.

Zach went to pick it up since he was off today.

The co-pay was still $50!

Say what?

When I asked him how much it was, I assumed they must have gone ahead and given me both month's pills.

How many pills were in my bottle?

60--two per day for thirty days.

Also, "No refills--doctor authorization required."

Huh?

So I call up the pharmacy, and the tech explains that this is a top-tier medicine, so the co-pay remains the same. Okay, fine, I understand that: it means it's too expensive to drop the co-pay. Then I asked if I would have to have my doctor's nurse call in another prescription once this month's ran out. He tells me that I just have to call the pharmacy. Oh, okay, fine. (Still doesn't explain the, "No refills-doctor authorization required" on my medicine bottles.)

I hang up the phone and explain to Zach about the medicine and prescription and assume the issue is over.

Well, my brilliant and money-conscious husband asks, "Does that mean we will have to pay another $50 next month?"

I jump back on the horn with the pharmacy and ask if we will have to pay a co-pay since I will only be getting 30 pills, which, when combined with the 60 I get this month, equals 90...that cost $50 total when I received them together.

"Yes, ma'am, you will [have to pay another $50 co-pay]. It's not us; it's the insurance company."

HUH? SAY WHAT?!?!

I'm not trying to cheat the system. I understand the whole "top-tier" issue; as I said, this is a very expensive medication. Apparently, such a prescription as mine is not entered as one prescription, but as four separate prescriptions, so I have to pay the same co-pay each time even if I am receiving half or a third of the original amount of pills. Say what? This does not add up. I understand their policy, but it is the principle of the matter. I am a rational person and can not accept that it is fair for them to charge the same amount when I am not receiving the same amount of pills.

So I ask if it would be possible for the doctor to call in both months' prescription as just one...so we only have to pay $50 once.

"I doubt it. You can try to call the insurance company."

I hang up the phone completely stunned.

*cue tears*