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Saturday, August 8, 2015

Medicinal Madness, Continued

I recently wrote a blog post which I titled Medicinal Madness about some insanity regarding medications and insurance coverage. Two insurance companies cover Trent's expenses because he is a transplant patient, and I referred to those companies as A and B. While I am only insured by B, much of Trent's care is billed first to A and then to B. While B generally covers medications after the annual deductible is satisfied, the anti-rejection meds are billed first to A and then to B. So, since the beginning of this year we have not really known what amount we were going to have to pay on a monthly basis for the one medication currently in question.

Along the way, we were told amounts ranging from $2775, to $220, and then $165, all for a one-month supply. The final expense, of course, would be dependent upon the amount B decided to pay for this vitally important medication. I monitored the website of B every day, eager to see what their contribution would be. We knew that we were getting close to satisfying our deductible, close enough that after one month's billing was submitted we would have satisfied that annual amount.

I will admit that we were thrilled at the thought of B paying some of the expense. We had enough money set aside for the three months of fills that we hadn't yet been billed for. We began to allow ourselves to see a light at the end of a long tunnel. In addition, I had been holding off on ordering some much-needed medication and supplies. I was almost out of the antibiotic I take daily to prevent rosacea from damaging my eyes, and I was nearly out of test strips for my glucose monitoring. I all but stopped testing my blood sugar; when the deductible was met the strips would be free. Until then they would cost the amount of the remaining deductible, which was far better than the $500 or more that they would have cost a few months ago. Instead of two antibiotic tablets a day, I began taking one every other day. Through the local pharmacy, a one month supply would cost about $60. If I could hold out for the deductible being met, three months' worth would cost less than half of that. So as you might guess, I have been stressing greatly over this issue because so many things were dependent on the processing of these claims. 

On Wednesday morning, I eagerly pulled up the website on my computer, hoping that the deductible was met. I also hoped that we'd find out that B had paid part of the cost of at least one of the amounts. Yes! There were numbers where previously there had been none! The amount we needed to pay on the first billed amount was around $160 as we expected. The amount we were responsible for on the second billed amount was...$1950. The company wasn't paying a single penny on either claim. I was disappointed but tried to find a silver lining. I knew that we couldn't be billed more than $165 by the pharmacy, so we wouldn't have to pay the full scary amount. And our deductible was satisfied so that would be great, right?

Wrong. Although they decided not to pay a single penny, they also didn't apply any of the billed amounts to our deductible. Sure enough, when I went to the pharmacy website, it told me that I could order antibiotics for over $100 dollars or test strips for nearly the same amount. And in our certainty that we would have a lower payment owing for the medications, we had spent a small amount of the money set aside for their payment. I began to berate myself for the fool that I was. Trent tried to tell me that we had both spent the money and were both responsible, but I didn't blame him, only myself.

A part of me was really crushed. I had hoped that the money we had so carefully set aside could be used for special treats for us later in the year. Maybe we could use it to celebrate our Anniversary or get one another something special for Christmas. I saw these things slipping away and felt sad for their loss. After a short while, I told myself that things aren't important, and I truly believed it, which is a good thing. I buoyed myself up to call insurance B and find out why the amount wasn't added to the deductible.

I had to explain all of the folderol for the umpteenth time, and asked why the deductible hadn't been adjusted. Apparently there was an error, so the person helping me began a research request to get the amounts adjusted. It would take up to ten business days to get fixed. My heart sank. Since I was on the phone already, I also asked why no payment was made. It turns out that since A paid x percentage of the billable amount, which is more than B would have paid if they had been the only ones billed, they figured that this was good enough. Why didn't the last person I spoke with tell me this, I wondered. I wouldn't have had my hopes dashed if I had known not to get them up. I tried to pin her down to telling me that they would not pay anything in the future, but she wouldn't do so, even though it seems to be the obvious answer.

I continued checking to see if the deductible was adjusted. Yippee! Overnight Thursday, it was fulfilled. I went to the pharmacy website only to find that they still didn't have that information. They did, however, know the cost of the two months' worth of medicine, so I took care of paying for them. Trent and I made a plan that I would use his meter to check my blood sugar if I needed to; his strips don't work in my meter, naturally. If I keep being frugal with my antibiotics, I can last until I get a shipment. I was able to order the test strips free of charge today, and will get in touch with my doctor to order the pills on Monday. We'll make it through.

I am ashamed to admit that when I found out yesterday that I still couldn't order my things, I quit fighting the crankiness that had been hovering around me. I jumped right into a pool filled with it, and let it drench my body and mind. If someone really wants to reform insurance and make people's lives better, I thought, they should make the monthly premiums count toward the annual deductible. Test strips should be universally sized like phone chargers, I thought. When Dr. Mike responded to my comment that I was wishing for menopause to begin and he said I was already in it because of my age, I should have asked him to notify my uterus about that, I thought. I am so stinking cranky, I thought.

Frustrations happen for all of us from time to time. Sometimes they just seem to pile up on top of one another like a huge pile-up during a football game. As much as we try to handle them with maturity and grace, every so often we just can't. We get depressed or frustrated, or take a swim in the cranky end of the pool. I'm ashamed that I got that way yesterday, but I'm glad that it was crankiness instead of a deep depression. Different types of emotional extremes, but one is much more damaging than the other. 

Soon, I will have my supplies and meds and will be able to let go of the stress that I have been carrying on my back. At least we know where we stand now as far as Medicinal Madness is concerned! I wish all of you good fortune and hope that your trips into the realm of medicinal madness are brief and low in stress. Be happy, and be well!