I wrote you the $4000 check now give me my drugs (or why COBRA sucks part two)!

So, last week I send the $4,080 check to my old employer so I could have two months of COBRA coverage (if that amount just put a shiver through your spine, think of how we feel. Then know that we have another $2,040 check to write at the end of this month before it’s over). It’s been six weeks since  I left my old job. That’ ‘s a long time to pay for medications out of pocket. It’s frightening to see all the bills roll in that say “coverage not in force at time of service” even though  I know that the insurance company will eventually pay all the doctors that we’ve begged to treat us during this time.

A couple of days ago, I called the benefits office of my old employer to confirm that they got the check and to see when we’d have coverage. While the gal in the office was quite pleasant, her answer was more of a good news bad news thing.

“Yep, we got the check.” she said.

‘So, when will we have insurance again,” I asked.

“Well (PREGNANT PAUSE), here’s a number that you can use for prescriptions (she rattled off a crazy combo of numbers) but…”

“BUT, what?” I said.

“But, I have no idea when United Health Care will have you updated in their system. It has to be uploaded. Then it has to spool…”

That was the point that I lost all interest to hear the rest of her message. I was slightly stunned. I just wrote a check that we really couldn’t afford for the right to continue our health care coverage and  no one could tell us when we’d have it again. I hung up disgusted.

On the bright side, we could get our prescriptions filled. So I called my hubby and gave him the number and planned to call in four of Rosie’s that were empty. Then I called the allergist to see if they could have my Xolair filled (which costs $4000 a pop. I’ve been off it for six weeks. Not a good thing for the start of allergy season.)

What happened next was a little dumbfounding. The nurse at the allergist agreed to attempt to call in my medication to the specialty pharmacy but she didn’t think they’d take the number over the phone. She thought I’d need a card.

“Good news!” she said when she called back. “They took the numbers. They are going to start the pre-certification process.”

While I could hear her smile through the phone, I was dumbfounded. It’s the same coverage for the same medicine I’ve been on for seven years. Nothing has changed. Yet, because we had a “lapse” in coverage (which according to the government it’s considered continuation) we now had to jump through hoops to get my drugs. I asked her when she thought I’d be able to get my shots and she answered as honestly as she could- she didn’t know.

It got worse.

My hubby called in his dwindling prescriptions to the mail order place and was flabbergasted to be told that our prescription drug coverage was cancelled the day before. He relayed this to me that night after work and was totally disgusted. We sent the freaking check, why don’t we have coverage?

Once again, I called my old employer’s benefit line to figure out how to get our medications. I got the same lady as before. I reminded her when she answered.

“I’m calling because we’ve been told we have no prescription coverage. I spoke with you two days ago.” I said.

“You didn’t speak with me,” she said (according to my notes, unless she has a twin sister with the same name working in the same department using the same tone of voice, I sure as hell did). “What’s your last name?”

I told her and spelled it. And, since I’m the only one in the world with that awkward, hyphenated last name, I knew I had her. I spelled slowly.

“Remember me? I’m the one that called to make sure you got my four grand so we could fill prescriptions for my asthma, a life threatening disease. Which my kid has too.”

Suddenly she did. And she told me we had coverage. Then she looked.

“Oh, my. You were cancelled two days ago. Must be a computer glitch. I’ll fix it right now and you’ll be fine. Let us know if you need anything else” and the line went dead.

Yes, I need something else. I’m paying OVER $6,000 for three months of health coverage that I’m not even getting. I can’t get my medications. I’m watching bills pile up and no one can even tell me when I can start the painful process of having to chase the insurance company to get everything paid. Won’t that part be fun?

For right now, I just want my drugs. And, I’m pissed that I can’t just write the astronomical check and make that happen. Our health care system sucks.



COBRA, you suck (and so does our health care system)!

When I changed jobs in February I was prepared to go where no woman wants to go-into the wonderful world of COBRA to continue our health coverage. I knew the premium would be steep but we can’t go without health insurance and can’t qualify for any on our own. So, we’d have to bite the bullet and pay an astronomical premium to have the right to have quality health care for 90 days until my new insurance kicked in. No big deal, right? WRONG!

My old employers insurance dumped us right away. Wouldn’t have been a big deal except that Rosie got sick and had to go to the doctor (that’s how we found out we had no coverage). God bless the pediatrician for understanding that we were in the black hole between employment separation and when the COBRA paperwork arrives. They treated her and prescribed a $200 antibiotic (which of course, we can get reimbursed the difference between the co-pay and what we paid when our insurance kicks back in) and they’ve been patient waiting for us to give them the sign that they can file the claim. What they didn’t’ realize is that it may come in the form of smoke signal as it’s taking so long to get insured again.

An employer has 30 days to get you the paperwork. During that time, it would be easy for someone to spend their emergency fund (if they were smart enough to have one) if they were in a car accident or God forbid diagnosed with cancer. Lucky for us, nothing has, and the good news is our doctors understand our plight. But, you can’t negotiate with the pharmacist at Walgreens when you need a prescription. And, the real cost of many of my asthma drugs is outrageous. I’ve actually had to go off one of my meds as the pharmacy wouldn’t ship it without insurance company authorization, even if I paid the $4,000 out of pocket. Ridiculous!

I’ve ranted about health care before. We have a broken system in America. Many go uninsured because they can’t afford to pay for care and don’t have jobs that provide a group health plan. Many go under-insured because they buy all they can afford and have shoddy coverage as a result. As someone who is totally, uninsurable I’ve always resented being tied to jobs to have coverage. Our health care system is bullshit and it needs to change.

We are lucky that we have the resources to pay the $6,000 it’s going to cost to have three months of health insurance coverage to close the gap until my group plan for my new job begins in May. But, writing the check makes me feel ill and explaining to my child that we’re flat broke right now makes my stomach turn. But, I’d hate to be in a position with no coverage in place. Talk about something that could be financially devastating.

I called my old employer yesterday to find out how long it would be once they got my check until the insurance kicks back in because we need to get prescriptions filled and I didn’t rally care for their answer. Once they get the funds, they immediately flip the switch on their end, but she couldn’t give me a good answer on how long it might take United Health Care to reinstate it. That scared me a little bit. I send them a big check for the right to have coverage (and have to do so within 60 days, they send no additional premium notices and if we miss one by 31 days they immediately cancel. Sounds like they WANT you to miss one) and they can turn my insurance back on whenever it’s convenient for them? That’s crap.

I have a sinking feeling that by the time I have coverage again, two months may have elapsed. And, we’ll have paid for thousands of dollars of prescriptions (on top of that $6,100 premium) that we’ll now have to refile (which once again they can pay when they get around to it). That SUCKS!

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