Friday, September 29, 2006

Mr. Pink's Healthcare Horror Story

The reason the hospital released Bob early was because he was able to give himself shots of the blood thinner, Lovenox. Prior to the "procedure", he had to quit taking the Warfarin (blood thinner), so he wouldn't bleed all over the table. After the procedure, it's important to thin out the blood again really fast, so you have to take the Lovenox shots for a few days until you can just go back to the pills.

Very few pharmacies carry Lovenox shots, but the one near the hospital did, so we went there.The area near the hospital is very poor and populated by people of color. As I'm waiting for Bob's prescriptions, one parent after another tried to get prescriptions for their children. And, one after another, they were told their children weren't covered by insurance, so they had to payfull price for the meds. And, one after another said, "That's OK. I know another pharmacy who will fill the prescription (lie). I will just take it there."

There was a consistency in the way they were trying to get medicine for their children. You could tell they drive from pharmacy to pharmacy, trying to get the prescription filled. It was so fucking sad.

Then, it was my turn. Bob's insurance also rejected covering the meds (the doctor didn't call it in). BUT, I didn't care. I KNEW I would get reimbursed given my past success with reluctant insurance companies. And, even if I didn't succeed, it didn't matter because Bob needed this medicine (as I'm sure the children needed theirs). So, I said, "I'll sort it out it later with my insurance company; I'll pay the full price now."

The total was $770.00!!!! If insurance had covered it, the total would have been only $40.That was an eye-opening experience for me. Since we haven't paid full-price retail for any prescription drugs in decades, I had no idea what current prices were. More importantly, I had no idea what the uninsured are expected to pay (when they clearly can't).

I just wanted to tell everyone in the pharmacy that I would pay for their medicine. That's when my stomach really started to hurt. I kept thinking to myself, "Am I in Darfur?!! The only thing missing from this picture were the flies. What medicines are these children not receiving? etc." It was horrible.

I called the insurance company when we got home. They explained about the authorization. Then they said, "You can just take your receipts back to the pharmacist, and they'll give you a refund." I explained that I lived in the sticks, and that I wasn't going to drive back (four hours round-trip) for a refund. I told them that they needed to reimburse me.

"So, you already purchased the medicine?"

"YES! Of course, I did. My husband needed it right away. He was released from the hospital only because he would have access to this medicine. You should be thrilled. You aren't paying for a longer hospital stay."

"Yes, I see here that this medicine is important. OK, we will reimburse you."

Again, I thought, "Even if you have insurance, you could be fucked by the company if you aren't aggressive on the phone (or understand what is being said to you)." After all, the goal of the insurance company is to place as much burden on YOU as they can get away with. It's a disgusting, horrific system. The 'Torture Bill' was passed yesterday, but it's been in effect for so much longer. How can one not cry for our country and our fellow citizens? I hope I never become that callous.

A couple of hours went by and then I had a phone call with the hospital about Bob's situation. I told them that I already paid for his medicine. I told them that what I told the insurance company, ending with, "Of course, I paid -- it was a life or death situation!"

The response from hospital was chilling. In a deadpan voice I heard, "You're in the minority. Most people don't get the medicine."

In other words, what they were saying was, "Like, (YAWN), yeah, we write the prescriptions, but we don't give a shit after the patient leaves."

If Bob hadn't received his medicine, he could have a stroke and/or a heart attack. Then, it would be back to hospital for even more intensive, more costly care. I'd like to know: How many patients INCREASE the cost of healthcare by NOT being able to obtain medicine in a timely fashion? Good God!