Yep. Those are big shots. Wait until you hear the price tag…

The nurse thought I was crazy when I looked at her and said, “Hey, wait a minute! I want to get a picture of this!”

She gave me a sideways glance and said, “you’re kidding, right?”

“Um, no” I said totally poker  faced. “You don’t know what I’ve had to go through to get to this. I HAVE to blog about it.”

She moved away so I could take the pick giving me what I like to call the “Whatever” face (I see it on my tween often). I moved into to get a good shot. She was looking at me kind of suspiciously but I didn’t care. I had gone through hell to have this and I was going to enjoy every minute.

Why yes, that's $4,500 of Xolair. No, I'm not kidding

Why yes, that’s $4,500 of Xolair. No, I’m not kidding

For those of you that missed the drama from last year, I had three different jobs, four different insurance policies (including a $6,200 stint on COBRA) and I had a hard time getting approved for the medication that you see pictured above. The interesting thing is for more than seven years, I stopped by the allergist for three shots every two weeks (I’ve often joked that if I’m ever left for dead and my family needs to ID my body, they can do so by the injection scars in my arms. Proof that I’ve read way too many mysteries) so there was medical history that supported the fact that I needed the shots. Unfortunately, every time we’d get an insurance company to approve me, I’d go through a lay off and switch policies again. So, we spent the year paying thousands of dollars for coverage that didn’t allow me adequate medications to help my asthma.

Long story short, I spent the latter part of the year, coughing and hacking. Gasping for air. Five rounds of Prednisone left me bloated, fat and crabby. I spent lots of nights staring at the ceiling and when I was able to sleep, I had night terrors and sweats. Needless to say I was crabby (thank God after 40+ years of drugs I can control roid rage). I couldn’t play tennis and in December my body completely fell apart and I caught every kind of secondary infection that had to do with the upper respiratory system. My body shut down.

A couple weeks ago, I got the call that I was finally approved to get my shots (Hallelujah!). However, there was a small problem. Xolair costs $4,500 a month and on my new insurance (yes, policy #5. My previous employer changed plans for 2013), my co-pay would be $454 a month. When the pharmacy told me that I thought I was going to fall out of my chair. But I held onto the arms and told them we couldn’t afford the co-pay. Once again, I was not going to get my shots.

But there was good news! My asthma is so serious (okay that wasn’t it) that I qualified for financial assistance from the drug company. This brought the co-pay down to $90 a month. I would have my injections after all!

When I went last week, everyone at the front of the doctor’s office was so happy for me (I have a 20+ year relationship with the practice and I think they felt bad watching me suffer all year) and I was elated. It was a long year off the drug that I was going to pause and take a picture of the shots. And, I didn’t care what the new nurse thought. I was looking forward to a healthy 2013 and the injections were the start!

 

 

 

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Why COBRA sucks Part 3

I’m getting ready to write a $2,000 check and I have to confess that I am more than a little bitter. This will be the fourth one I’ve written this year for COBRA coverage which is “supposed to” be continuation of benefits after losing a job ( I say supposed to because you get dumped off a plan immediately and then have to go back and chase an insurance company for months to recover the cost of your healthcare expenses that incurred when you were in the black hole waiting for them to get your payment and turn your benefits back on. It is complete and utter crap.)

At the start of the year, we paid $6,000 in COBRA payments waiting for benefits at my new job to kick in. Since I lost my job in August, we are making one more $2,000 payment until our new benefits begin in October. We aren’t making the payment because we actually used the insurance in September (we paid cash for all our prescriptions and cancelled all doctor’s visits). We are making the payment so we have what they call in the insurance world as “continuous coverage” so when we get our new insurance they can’t say we have preexisting conditions and they will cover us. We are paying for the right to have health coverage moving forward.

I’ve been very vocal in the past that I think we have major issues with our health care system and this is yet another example of why we need solutions.  What if I hadn’t been in the insurance industry to know about continuous coverage (most people aren’t educated on those types of issues)? I’m sure there are thousands of people every year that lose jobs, can’t afford the premiums and pay out of pocket for months not knowing that they’ve now affected their insurability in the future. And, guess when they find out? When they get the bill from the doctor for a service they thought would be covered (they have group coverage, right?) and the insurance company declines to pay. Crap.

I am lucky. I can pay the premium and I know how the rules work. But, there are lots of others who don’t and make the fatal mistake I’ve illustrated above. Or, they can’t afford to pay at all and they go without insurance for an extended period of time. We need health care reform. Badly. I am done ranting. For now.

 

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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