Wednesday, April 4, 2012

In which we survive yet another health insurance boondoggle

Tomorrow Big Guy finally goes for a check-up. He was scheduled for one in early January, but when we went to fill a prescription on January 2 we found out that his State-sponsored insurance coverage had been terminated. It took three weeks to find out why. It took five weeks after that to get the coverage reinstated. It was a long and ugly story, punctuated by two occasions on which we needed to get $200+ worth of prescriptions filled.

Big Guy has been covered for exactly 35 days now. Today the doctor's office called to say that they were trying to register him for tomorrow, but the system kept saying his coverage has been discontinued.

Yes, insert the expostulation of your choice.

Thankfully, neither Andrew nor I ended up in the ER with heart failure. Neither of us were detained by the police for criminal activity, either. Which goes to show that if you set the bar low enough, even we can count  every day as a success.

But there was actually more success than that: after a near-stroke-inducing phone call to customer service, Andrew excavated a name from his files and found the number of a woman who'd helped him last month. And that competent woman, bless her, was able to get the coverage reinstated in a matter of 20 minutes.

At any rate, it occurs to me that it might be useful to relate some of the tidbits of information we picked up in the course of this adventure, in the event that some of it's helpful to others:
  • Do not hesitate to involve your local elected official's office in resolving problems involving bureaucracy. With health insurance you'll have to either sign a HIPAA release or do conference calls with the elected's representative, but it is helpful to have someone working with you who can toss the state senator's name around.
  • Some clinics, even at well-known hospitals, will work with you or waive fees if you are working in good faith to procure insurance or have applied for state coverage or Medicaid. It's always worth asking.  Big Guy was able to continue seeing his therapist and psychiatrist for two months without charge. 
  • Some of the big-box stores (Walmart, Target, etc.) have reduced-cost prescription programs for common medications. One of Big Guy's meds was available for $10 from Target instead of $90.
  • Check with your pharmacist to see if there are price differentials between different forms of the same medication. We discovered that the cost for one drug dropped $70 if we switched from tablets to capsules. The doctor had no idea this problem existed.
  • If you're completely broke and don't have insurance, some of the Pharma companies will provide certain medications free of charge or at minimal cost. You have to prove financial need.
May you never need to use any of these tips. And if you do, you may email me in hysterics and I will give you my phone number and you can call me and expostulate for an hour and I will be nothing but sympathetic. I promise.


  1. Those are some great tips. I had no clue about the cost difference between delivery methods of meds, i.e., tablets vs. capsules.

    I've heard of people getting senators involved for passport issues, but not insurance.

    I really admire your and your family's attitude. You seem to have adversities that make some families with only one child and two full-time incomes fold like a paper doll under the pressure.

  2. Since we are in a year-long sort of limbo between US residence and Italian, we no longer have health insurance in either place (though I think an Italian emergency room would take us).

    Before we moved, Bob got a year-long prescription for his blood pressure medicine. When he was back in the US last month and went to refill it, the pharmacist at Duane Reade told him that for $20, he could get a prescription plan for people without health insurance, which he did, and he saved a whole lot on his refill. Who knew?