Medicinal Madness

What an interesting week it's been. There were a couple of issues, medication-related, that have succeeded in making this Lunatic a bit more looney than usual. I hope that you'll forgive me for indulging my need (desire?) to vent a bit by writing this blog post.

The first situation I'll tell you about started out fairly simply. Trent had his annual extra-intensive blood tests for the anniversary of his kidney transplant. Although labs are run throughout the year, once a year there are extra tests to assess the patient's overall condition. There was a result (not kidney related) with a much lower than normal number. When Trent asked his doctor about it, Dr. Wiseman said he would refer it to the pharmacology specialist because some medications could possibly cause the problem. We also had the labs re-run to check the status.

When we got home, we had a message to call the clinic. The caller didn't state her name or reason for calling, but asked Trent to call back. We looked at the labs, which had the best number in the affected area that he's had in two years, and thought she was calling to say so. The clinic was closed, so Trent called the next day. There were no notes in his chart about who called, so we didn't speak to Ms. Hospital Person. We did a few minutes later when she called, though.

Here's how the call went, abbreviated a bit so my fingers don't get worn out.

HP: (After some talk about the number still being too low, and advising Trent to quit using acetaminophen and anti tummy-irritation pills.) What is your pharmacy, I am going to call in a prescription for a whosiewhatsis for his GERD. 

ME: (After explaining Trent does not have GERD, he just takes meds that irritate the stomach.) I'd rather get something over the counter because we haven't reached our deductible and it will have to be paid for out of pocket.

HP: (After assuming that we are on Medicare Part D and have hit the "doughnut hole," and saying that is the situation. I correct her and tell her that it is private insurance and we have not hit our deductible yet. I am feeling repetitive.) What is your deductible?

ME: (After counting to ten so that I don't tell her it's none of her stinking business.) I fail to see what difference that makes.

HP: Says it might be a tiny amount. This makes me even more irritated because if it was a tiny amount, I wouldn't be worried about it, would I?

ME: Lets her know that it could cost us hundred of dollars.

HP: Says she will consult with the head of her area, who we wish had called us in the first place, and call us back.

So, a while later, after Trent tells me that no, I wasn't being testy, she was indeed being irritating, especially because she doesn't listen, HP calls back. She tells us that she has a box of samples to give us, sparing us the huge expense, and she will leave them at the front desk. Not feeling eager to make another forty-mile round trip to visit the hospital again this week, Trent asks if the box can be sent to the hospital's Family Health Clinic in Westminster, CO which is much closer to us. 

HP: Is that on the sixth floor?

US: No, it's a clinic in Westminster.

HP: Is it on the sixth floor?

US: We'll come pick it up.

I won't even go into her telling us how to eat to avoid stomach acid and that we need to not eat fried chicken. What the heck? Who said anything about fried chicken? Like a pot of stew, I simmer for the rest of the evening.

The second scenario actually began in January. We received a letter from the new mail-order pharmacy that is on our insurance plan as of January 1 this year. It instructs us that we need to order Trent's anti-rejection medicine through them rather than picking it up at the hospital. Picking it up was a breeze. We'd drive down, get the meds, pay nothing, and go home. The letter says that we have to order the medication, pay for it, fill out a form authorizing them to bill insurance company A and then insurance company B.

This worries us because we are pretty sure that the medicine is fairly expensive. I call the pharmacy on the weekend to ask if insurance A can be billed before the meds are sent out to us. We are told no, that is just how things are. So I ask the price, which I am told will be $2775. No, that is not a typo. I tell him that there must be some way for the billing to be done in advance; he replies that they fill prescriptions for people with real problems. Apparently he doesn't realize that dying from rejection of a transplanted organ is serious, or that having to move into one's car because one month of generic medicine costs more than two months of rent is pretty serious as well. After crying for about an hour, I calm down. We make arrangements to pick it up at our supermarket for almost three hundred dollars.

A few days later we talk to someone in the Specialty Pharmacy who says the billing can be done to A at the point of sale. We receive the meds and fill out the paperwork. Somewhere along the way, we are told that the medication, if not paid for by insurance B, will cost no more than $165. Three months after the first order, we still have not been billed for the first order. I call to see what's up, and am promised a call back. When I receive this call, I am told that the pharmacy screwed up and forgot to bill for the first fill and it is too late for them to do so, so that's a freebie.

That first order was in February. We still do not know how much the medicine costs, and it's the end of July. In the meantime, after numerous calls, I am told in early July that A has paid for a couple of months of fills and the pharmacy will bill B with a paper bill. It will take weeks to know what we owe. Meanwhile, we get paperwork from A about the February order. Rounding out the dollars a bit, here's what happens. Pharmacy bills A for $1950, and A says they can't charge that much, they can only charge $800. Of this, they may not bill us more than $165.

Okay, so far, so good. I keep an eye on B's website to see whether or not they are paying any of that $165, and how much. And then yesterday I see that the pharmacy has indeed sent B a claim for the prescription. And it appears that they have billed for the entire amount of $1950! Does anyone else see this as a problem? It makes me mad on behalf of insurance B, as well as all people who have insurance premiums to pay. I use a phrase that I never use - I tell Trent that this is why we can't have nice things. A company that has been paid $650 so far still bills the entire inflated amount in an effort to get more money. Of course it is possible that the claim information I am seeing does not reflect all of the claim information. Perhaps the bill includes the information from insurance A and their payment. But it sure looks rotten, doesn't it?

I am trying not to lose my mind worrying that more than seven months into the year, I have no idea what the medication will cost and how to plan our budgets other than with the guessed-at dollar amount. That's sort of like telling a bee not to fly toward a flower. It's not in my nature. We'll see what tomorrow or next week or next month will bring. I hope for a quick ending to all of this medicinal madness.


p.s. The super-fancy samples that we drove across town for ended up being something that we can buy over the counter in generic form at a cost of about $10 per month. At least we'll know if it works or not before we have to buy it!