Friday, October 14, 2005

DUH. Just Don't Get Sick.

(See how nice I am. I drop off the face of the earth, then return only to moan about insurance again.)

We've had health insurance through Jete's job since we got married. At one time, it was awesome insurance. So awesome, in fact, that sometimes I think it was only a dream or fairy tale. It made up for the fact that he makes so little money. Dirt cheap weekly premiums. And? The Happily Ever After? It was only 5 dollars - FIVE - for every doctor visit and prescription. No extra for "specialists" or "tier 2" drugs. Five dollars, across the board.

If only Ethan was born a little sooner, we might have really taken advantage of it. As it was, they paid for every penny of his NICU stay and his first 2 years of seeing specialist after specialist. Not a question asked.

The past two years, costs have increased, and the plan changed from one company to another - HATE HATE HATE. With every test, drug, or doctor comes another fight. I have called them no less than 20 times in the past few months to straighten things out, and I still have almost a thousand dollars in unpaid medical bills buried on the counter. Because even after all the begging and pleading, they only pay a percentage of every bill. Sometimes, it hardly seems worth all the effort.

Over time, we realized - hell-o! - just switch carriers! My company is large enough that you can choose from 4 different insurance companies, including the nicer people we had before. When my reenrollment period came around, I'd just sign us up for that one. The Big Plan was hatched.

This week, we got the paperwork to sign up for health benefits at my company. Someone must have alerted them to The Big Plan. Because now, their benefits are awful, too.

You still have the option to choose from the different carriers - for your doctor's visits. However, all prescriptions, no matter which plan you choose, will be administered through my Arch Nemesis. I can't get away from them.

(Let me just say to you companies out there: you get what you pay for. They may be cheap, but that's because their service SUCKS. Plain and simple.)

Not only will it be administered through them, but they have gone to a coinsurance system. You will always have to pay 25% of the cost of the drug, up to a maximum. I did the math, and if Ethan's drugs fall into the categories I think they do, we'll be paying about $300 a month just for his prescriptions. (That's on top of the $25 copays for every doctor visit, often once or twice a week.) The three-month mail-away option only saves you a few dollars, and it's not really an option since his dosage changes so often.

So now, I've got exactly 2 weeks to crunch all of the numbers. Jete's insurance SUCKS for one set of reasons, and this insurance SUCKS for another set. Which option sucks less?

Ah, a mathematician's dream.

As numb as I am when it comes to insurance stuff, two things really bothered me about this:

1. The condescending language in the literature.

They said they are doing this to encourage us to "ask the doctor for a different drug if it is too expensive." See, this assumes we just blindly take whatever drugs our doctors give us with no thought for the poor MULTI-BILLION DOLLAR COMPANY paying for it. Boo-freakin-hoo. We don't have a choice. I'd love for Ethan to take no drugs. If there's a plan that guarantees that, sign me up. (And for the record, if there is a generic available, we ALWAYS ask for it. I'm not looking to make drug companies richer either.)

They want to encourage us to "shop around to different pharmacies for the best price." Listen, I hate my pharmacy. I'd LOVE to switch. They are always mean to me, they never ring things in right, and they usually don't have his full prescriptions available. But they are the biggest ones out there. And they're open 24 hours. I can't take the chance that his drugs will take a week to come in, or that they won't be open on a Sunday evening when we realize we're out of a seizure medication. Sorry.

My personal favorite: they're doing this "so that we can see just how much our drugs are costing". Hi? I'm not an idiot. I know EXACTLY what Ethan's drugs cost. I can read.

Oh, I know! How about - we just don't get sick! That will save us tons of money! Why didn't I think about that sooner?

2. This is a HUGE change with almost no warning.

Why do they always feel the need to wait until the last minute before springing stuff like this on people? I have two weeks to crunch my numbers. I'll complain and moan, but the bottom line is, I have a choice. I'm lucky.

I have a single friend with 3 kids who also has a son with special needs. Her son is on a lot of experimental drugs. They're going to cost her over $400 a month. I don't know how she is going to do it. It would have been nice if she'd had some time to save up, explore other options, even process what this means for her. It still would have sucked, but it would have been nice.

I guess that's what really made me the maddest. The feeling that no one cares. There's no nice in business. This is our health insurance, but they aren't interested in making us well. They're interested in making a dollar. And this plan must save them a lot of money, plain and simple.

I got the feeling from all the literature that they've been preparing themselves for "whiny" employees for months. They've got stock answers ready for us when we complain. They've documented all the reasons that this is a good thing. So read up and shut up.

Nowhere in the literature is the acknowledgement that some of us are going to have to fork out a lot of money every month. That they know we have no choice about that. That they know it's going to be hard for us. And maybe, that they're sorry. That they did the best they could for us, because they value us as employees, but they had to consider the good of All over the good of the Individuals. I could understand that. I could respect that.

Yeah, I know. I'm looking for fairy tales again.

In between crunching numbers, I want to draft a letter to the benefits department. My friend already sent one and got a stock answer back, but I want to put my two cents in. I know it won't change anything. I know they probably don't even care. But I just want to try to make them see the individuals under that pile of money. We all have a story to tell, and if nothing else, I want them to hear mine.

In the meantime, I'm washing my hands 100 times a day and spraying everything down with bleach. No one else is my house is allowed to get sick. Not for the next decade or two.

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