Tearing up over a headline on the cover of People magazine, which I happened to glance at when I walked past it at the pharmacy, was the telltale sign that depression symptoms had returned. I was already pretty sure they were back, it’s why I was at the pharmacy.
Although I was
perfectly mostly happy with Wellbutrin, I had to reduce my dose because, thanks to a migraine attack, my brain is now so sensitive to Wellbutrin’s side effects that I am massively dizzy on the dose that manages my depression. Cutting my dose back, the dizziness finally became manageable (though still present) on Monday… at the same time it stopped keeping the depression at bay.
I’m already frustrated by the needs of my ever-changing brain, but I was hopeful a new antidepressant would help me balance all my competing needs. Or I was until my insurance denied coverage. Now my doctor has to jump through constantly moving hoops to prove that, yes, this is the drug I need.
While I wait to see if her appeal will be approved, I can either be so dizzy that I can’t move my head and can’t look at the computer or I can let my depression symptoms build so that I have no motivation to get out of bed and cry at everything. Either way, I can’t work, can’t run errands, and can’t do anything around the house. I could try another yet another generic antidepressant, though I’ve already tried many, and would have to decide which I prefer, potentially gaining a ton of weight or losing interest in sex.
I don’t have much faith in my doctor’s authorization being accepted. Since the first of the year, Hart’s been working on a getting a doctor’s authorization approved for a drug that I was told would definitely be covered under our plan. It’s a drug he’d been taking for months, paid for by the same insurance company, until the rules changed with the turn of the calendar page. Now he’s without a drug he needs. There is a replacement, a replacement that he’s already tried. Last time it increased his migraine frequency so much that I lost sleeping worrying that he was developing chronic migraine.
I miss the days when my doctor and I got to weigh all the relevant medical factors and decide which medication was right for me. Yes, I could pay for these drugs out-of-pocket (assuming I could afford them), but I already pay a small fortune for health insurance each month. Being told a service will cover what I need, tethering myself to that service for a year, and still having to wheedle and cajole to get what that service supposedly includes is absurd. Especially when all that time spent on the phone and submitting paperwork is unlikely to result in me getting the coverage I thought I was paying for. Tell me up front whether the treatment I need will be covered so I can make a fully informed decision, don’t lock me into something then change the rules.
That’s what I’m angriest about. I understand why insurance companies don’t cover certain drugs or treatments. Yet I did everything I could possibly do to make an informed decision, including 17 hours of research, questions for my insurance broker, and hours on the phone with the insurance company. Now I have a yearlong commitment to a health insurance plan that’s not providing the coverage I was assured they would provide.
I get that health insurance is a mess right now. I get that companies are scrambling to make a profit now that they have to provide coverage to people like me. And I am grateful to be able to have any insurance coverage for my entrepreneur/freelancer household. But how is that companies are able to provide only basic information for a consumer to use to choose a plan, give half-truths (or lie outright) when asked questions, then delay coverage for months? I can’t think of another consumer service that operates this way successfully. Certainly not one that requires a commitment to paying thousands of dollars over the course of the year, then telling the customer, “Oh, wait, we’ve changed our minds.”
How is this OK? How can that happen without repercussions?
9 thoughts on “A Health Insurance Rant”
I will keep my story to the facts.
1) I’ve had the same coverage since 2010. Same deductible (an HSA), no co-pays. It has been “grandmothered” in (thank God) due to the President changing the requirements that were initially part of Obamacare. Plan doesn’t cover pregnancy or mental health.
2) The premiums have more than doubled since 2010. I now pay over $1200 per month for a family plan, total deductible is $3500 (includes everything that is covered). That after the Federal government spent how many billions for this program?
3) I pay for it out of post tax dollars (we do get an income tax reduction on the amount spent due to it being an HSA – but that doesn’t include premiums) – none of it is paid for by employer or anyone else.
4) The percentage of the premiums that we could get an income tax reduction on decreased directly because of Obamacare. (I believe before Obamacare you could get an income tax reduction on premiums over 10% of gross, Obamacare changed that to 5% – but don’t quote me on the specific numbers here – it reduced it be 5% or so).
6) I have a dependent with a chronic disease so we hit the deductible every year. This year we will spend over $19000 on health care (premiums, deductible and paying for other things that aren’t covered by insurance – vision, dentist, etc.).
7) My wife works for a school district that offers health insurance (the single plan is considered affordable so we can’t get any subsidies if we wanted to change to a plan on the healthcare marketplace). Unfortunately, the family plan being offered has premiums that are several hundred dollars a month more than what we currently pay, that coupled with a deductible that is twice as high as our current plan and with a 20% co-pay to boot. So that really isn’t a very good option because our pay certainly isn’t going up several thousand dollars a year to be able to make up the difference.
8) I believe 2016 will be the end of the grandmothered plans, so we have to change from something that is really expensive, to something that is not even remotely affordable.
9) So, given this – now what? Not get insurance? Kick my chronically ill dependent out, and stop providing support so she can claim to be independent on her taxes and then get Obamacare health insurance subsidies? Lots of great options!
10) We consider ourselves very fortunate in that to date we have been able to make it work financially, although every year we keep taking a bigger step backwards. However, I’m afraid next year, if we are forced to get an Obamacare compliant plan with its drastically higher premiums, deductibles and co-pays, that step back will be too large, and we will have to do something drastic to simply pay our day to day bills.
11) One idea that could help a little is to make all health care costs (premiums and any payments) 100% tax free (including social security and Medicare). This would make it the same as those how have their health care payed for by their employer that have that benefit given to them in pre-tax dollars.
It’s not just the insurance companies. It’s the drug manufacturers that want so much for the reimbursement of the research and development of their miracle drugs! Just like the hospital that charges over $900 for a blood test. Our insurance negotiates the contracted allowable cost down to $525 which we still have to pay toward our deductible. It’s still an insane amount, artificially inflated by consumer demand. Unfortunately the ACA did nothing to address the outrageously high cost of US healthcare.
Ellen, I agree. There are so many different factors contributing to the problem and in this political climate, I cannot see how any will be resolved.
Dealing with health insurance is incredibly frustrating, and of course we are doing it while we or our loved ones are sick. A lot of people are making a lot of money off of me being sick, and they don’t mind playing games, distorting facts, and giving me the runaround while they make that money.
Melanie, it does sometimes feel like we’re being preyed upon because the very fact of being sick reduces our ability to fight for coverage. Being sick is exhausting, not just for the people who are sick, but for those who care for us, too. Few people have the energy and/or time to fight.
I agree that prescription coverage bait & switch is a huge issue! You look and see that your prescriptions are listed on the formulary, but they fail to tell you they:
(1) require a pre-authorization approval which they will never give you, often as drugs are prescribed off-label and you won’t have the condition its FDA approved for;
(2) are part of a “step therapy” program where you have to try & fail numerous cheaper drugs first, even if they aren’t medically appropriate for you, and which also wastes time;
(3) have a quantity limit;
(4) have a ridiculous cost for medications (specifically high co-pay brackets for brand name, or when you have to pay a percentage which sounds good in theory, but even 10% or 20% of a medication which is several hundred dollars or more is a lot); and
(5) can change their mind at anytime and revise the policy.
Thankfully I have coverage through my husband’s employer which is for the most part quite good. We pay extra for the best coverage they offer, and I won’t consider trying another plan even though the out of pocket costs may look like it would be in our favor, mostly due to the unknowns.
Tortoisegirl, that’s a great summary of the issues. I can’t tell you the number of times I’ve lamented the loss of corporate health insurance! As much as I miss it, having health insurance contingent upon employment–and upon an employer providing insurance–seems absurd to me. Where the country is at right now isn’t a solution, but where we were 15 years ago wasn’t more realistic. There are so many systemic problems on so many different levels that I cannot see how we’ll move forward.
I do not believe that the insurance companies are ‘scrambling’ to make profit. Nobody, esp. the insurance companies do not run a business if they are not making profit. Its more, how ‘more’ profit they can make at the cost of everyone’s suffering. IMO, healthcare mandate is a boon for them making profit, irrespective of how much political cribbing going around.
US healthcare model is probably the worst in the world. Someone who has lived around different developed and developing countries, nowhere did I face so much trouble in accessing healthcare. Its remarkably frustrating that there is absolutely no political will to fix the system, but the corporate greed wins.
Noel, even if a publicly traded company is making a profit, they have to continue making more profit and continually prove their worth to shareholders (some tech companies aside). It’s not just that a health insurance company has to make a profit, they have to continue increasing profits to keep shareholders happy.