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How to Endure and Possibly Triumph Over the Adorable Tyrant
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« May I Firmly Suggest: Show Your Work | Main | Ten years! »
Monday
Mar102014

On the bright side, I have something to post about 

The other day I did my quarterly pilgrimage to the ol’ psychiatrist, as you do, and from there I scurried to the pharmacist with a slightly increased dose of Prozac (thanks for nothing, endless winter) and my usual anti-anxiety pills, which I keep on hand for the occasional anxiety attack, which this winter became somewhat less than occasional (hat tip to polar vortex and relentless sun deprivation!). I returned an hour later to pick up my pills, and the pharmacist informed me that while the Klonopin was no problem, my insurance company wouldn’t pay for the extra 10 mg of Prozac due to “deductible.” You’ll have to take my word for it that a deductible that only applies to certain medications is, in our medical plan as well as probably everyone else’s, nonsense.

Well, okay. I politely refused to pay hundreds of dollars for 10 mg of Prozac, and made a note to call the insurance company, which I will do on one of this free days I have, when I delight in nothing more than listening to hold music all afternoon. Meanwhile I will consume a Skittle each morning and hope the placebo effect takes hold.

The next day I visited the pharmacist with another prescription, this one for Henry's eczema cream. (I think we can also blame this on the winter, which I'll go ahead and do.) Again, returned an hour later, only to be told that the insurance company would pay for the cream but would not pay for it in emollient form, which is what the doctor wanted, being that my son’s skin has turned to bark. I was confused about the difference between an emollient and a non-emollient, and the pharmacist looked weary as he said, “It’s just adding a few lipids.” Which I now want to put on a t-shirt. Just a few? Do you count them out? Do you have lipid gobs floating around in a vat back there? Are they sentient? Of course they are.

I know other people have nightmare insurance companies and pay untold thousands every month and in the scale of things 10 mg of Prozac and “a few lipids” isn’t life or death, but we pay a thousand dollars a month, and for that amount I would think I could get my son his lipids. And my brain could have its little Prozac bump. (And this plan is a huge improvement over the one we had in New Jersey, where we paid almost $1500 a month and they denied practically every claim. Including one for pink eye, because it was a “pre-existing condition.”)

Maybe if you want to save money, insurance companies, maybe you forgo having your employees waste their time squinching their eyes at our piddling little requests, denying us our lipids. Oh, I don’t know. I would come up with a decent ending to this post but right now I have to convince my son to smear non-moisturizing corticosteroids all over himself. Would a few lipids make this an easier process? I'm not sure, but I can tell you that the Prozac would have helped.

Reader Comments (19)

Health insurance companies are the worst. I got our new insurance cards for the year, and they only have my name on them, even though I carry the policy for me, the husband, and our two kids. When I called to ask them about it, they said it was just the way the new cards are. When I asked what would happen the first time we showed them at a new doctor's office or, worse yet, the ER, and it was only my name, the rep said, "Well, they should be calling us before they do anything anyway." I'm sorry. What? Did you really just suggest that my medical professional's office should be calling the insurance company of Every. Single. Patient. every time they come in?" And what happens at the ER in the middle of the night? SINGLE PAYER NOW!

March 10, 2014 | Unregistered CommenterNicole

My doctor prescribes my 50 mg medicines in 10 mg doses because that's what my insurance will pay for. So, every day I take about a dozen pills. I hate insurance companies.

March 10, 2014 | Unregistered Commentercsmith

I'm so sorry. I go through this every 3 months with my prescriptions. Insurance company won't cover my low dose of hormonal birth control because it's "name brand" they only cover generics... there is no generic in a low dose. I've take the regular dose, and no-one wants the massive raging version of me on that. Regardless watching the poor Pharmacy Girl's eyes bug out as I suck it up and pay for it is always a little extra twinge of frustration.

Have you tried coconut oil for your son's skin, it may not cure it, but it certainly provides some relief when my daughter's gets bad.

Amazing what these companies are doing these days. Best of luck.

March 10, 2014 | Unregistered CommenterKatie

Insurance companies are money-making machines for their boards of directors. For everyone else they are money-taking machines. I grew up in Connecticut, land of steady habit and insurance companies, so I know this for a fact. That, and I've had more prescriptions refused because they're "not in our formulary" than I believed possible.

March 10, 2014 | Unregistered CommenterLisa B

Ah yes. My insurance company will not let me automatically renew my post-cancer pills because they allow automatic renewals only of "preventive" prescriptions. And here I thought that was the point of my taking the pills....

March 10, 2014 | Unregistered CommenterMJ

Wow - I thought I was the only one bumping up her meds due to this crazy cold. I think the plan is 5 mg and 3 chocolate bars for every 10 degrees below zero.
(does that make any sense? i'm also waiting for my prescription...)

March 10, 2014 | Unregistered CommenterLyla

I get my Prozac from Walmart in a 90 day supply of 40mg for $15 or less (can't remember, lol) and pay cash since I don't have insurance. Please check into it. I find they are so cheap on meds, in most cases less than half of what others charge.

March 11, 2014 | Unregistered CommenterKim

We have what I've always considered to be Very Good Insurance, but late last year they sent us a terrifying letter in which they said that my son's Abilify would no longer be covered (it's something like $800/month out of pocket), and they'd like us to try a generic instead. My son suffers from debilitating anxiety and depression and it has taken YEARS to find the right pharmaceutical cocktail for him, oh and also, THERE IS NO GENERIC ABILIFY. So they were basically telling us we'd have to switch him to a completely different drug (again). Fortunately his psychiatrist was able to get them to cover it for another two years but my own anxiety is already amping up thinking that he may have only two years to feel "normal". OY.

March 11, 2014 | Unregistered CommenterKathy S.

I can't even get a therapy appointment to get a refill anymore because of insurance. I HAVE INSURANCE. But they no longer cover "routine" therapy appointments. Eh. I guess I could fork over the $350 for the session but first I have to find the tree that has the magic money.

March 11, 2014 | Unregistered CommenterArnebya

Kathy S.: OY is right. I hope the two years gives them time to wise up.

Arnebya: Yup, can't afford therapy, either. What's the equivalent of therapy? A sun lamp? Weekly neck rubs? (You know you can probably get a refill from your g.p., right?)

March 11, 2014 | Unregistered Commenteralice

This winter has been AWFUL for the depression and anxiety not only because of the cold but because of the unpredictability. And all the changes. (And yes my eczema is worse, too.) AND the insurance company dropped the prescription drug coverage with the new year and now offers a "discount" on prescriptions but only for 25mg/day of generic Zoloft (I take 200mg/day) so now I have to pharmacy-shop to try to find the least horrible amount. And they keep changing my group number between when I make the appointment and when I go to the doctor so the claim gets denied because the new card arrives after the appointment. Ugh.

March 11, 2014 | Unregistered CommenterMeg

This is madness! I have no words, but I have heaps and heaps of helpless fury on your behalf.

March 12, 2014 | Unregistered CommenterDontBlameTheKids

Wow! Just wow!

I live in Canada - and yes we have medicare which covers doctor visits.

But unless you want to spend hours/weeks/months/years (depending on the situation) for a spot in the hospital to open for whatever test you need, you go privately to a clinic and claim it on your private insurance which our province obliges us to have.

Mine was substantially jacked up last year to a little over $2000/year for family coverage. And they cover all blood tests, x-rays, therapy, etc at 100% with a $50 deductible for the year. All dental work is also covered 100% (with some yearly limits.) And all RX drugs are $3 each - no matter their cost.

My insurance is better than others that I know. Most only get 80% coverage including RX drugs, but pay a lot less than I do - so it's a trade off

But your stories are mind-boggling to me. And sad. And I feel for all of you. It's terrible how much you pay and what little you are getting for it.

I will never complain about my health insurance cost again.

March 13, 2014 | Unregistered CommenterAEMom

But - I pay 17% tax on almost all purchases and personal income rates are insane as well - so don't hate me too much! :-)

March 13, 2014 | Unregistered CommenterAEMom

Holy Mary mother of God. One thousand dollars per month? Move to Australia.

March 13, 2014 | Unregistered CommenterMiranda

Thank you all for being outraged on my behalf--on behalf of AMERICA.

I didn't even share the story of how we're still paying off an ambulance bill for almost $2000 because the ambulance was "out of network." Like you ask an ambulance what network they're in when your loved one is passed out on the concrete. GAH.

March 13, 2014 | Unregistered Commenteralice

I second (and third and fourth etc) all the outrage.$1000 a month is bonkers. Move to England and spend it instead on tea and crumpets and ever and pimms. (And umbrellas.).
Cold weather is a total bitch for excema. For what it's worth, see if you can get your hands on a brand called La Roche Possay (see, if you lived in England this wouldn't be a problem...). The do a cream called Lipikar Baume, which is nothing short of miraculous for all nasty skin conditions, particularly excema. No meds so you can get it over the counter. Poor Henry. Poor you all. Crappy weather AND shocking healthcare system. Tell me you've got a good liquor store near by??

March 14, 2014 | Unregistered CommenterJessica

May I suggest Super Salve from from creationsoap.com for Henry's ezcema? It's a Calendula and Comfrey Salve. It has helped my son's diaper rash, my niece's ezcema and my weirdo dry patches. For $11 it can't hurt to try.

March 19, 2014 | Unregistered Commenterjoaaanna

Your system scares the c**p out of me! I moan about our National Health System (I'm British) but reading posts like this make me eternally grateful! We pay nothing to see the GP or for a trip to hospital, and we pay a flat charge of £7.50 (about $12) per prescription, with certain prescriptions such as cancer meds, diabetes meds and birth control being completely free of charge. I remember Tamiflu being free as well when we had the swine flu outbreak a few years ago.

I'm pretty sure I pay higher taxes than those in the USA (20% VAT hurrah!), but I think it's worth it for the peace of mind I get from knowing I will get decent medical treatment and it won't bankrupt me. It would be nice if it were a little faster, but having had an operation and a couple of trips to A&E in my time, I can say the NHS has never let me down.

March 25, 2014 | Unregistered CommenterA-M

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