Just in case you've stumbled upon this blog as the result of searching for "big guns," "women with guns," "right to bear arms," or some other such bullhonky, this post is actually another rant of a crazed politically liberal woman with an independent health insurance policy and a child with exceptional healthcare needs who is waiting in fear for the envelope from Anthem Blue Cross that will inform her that her monthly premium will be rising by some outrageous amount in February of 2013. If you were, in fact, hoping for a photo of a woman with a gun or were just shopping around the internets looking for confirmation of your insane need to protect your gun rights now that the country has elected -- for the second time -- a half-black socialist who is intent on taking over the country you love -- well, you've come to the wrong place. Because this blog is actually about the ridiculous fear that many of us who own Anthem Blue Cross insurance policies have about the upcoming proposed rate increases. It's also about the confusing parts of The Affordable Care Act and insurance exchanges and what they might mean to us and when they kick in and what more do we have to do and how do we do it? This post is also about the chat I had over the counter with the nice pharmacist at The Rite-Aid yesterday about whether or not Anthem has added clobazam, the drug that actually helps Sophie, to its formulary so that it will cost $30.00 instead of $400.00 or whether I should just make my plans to fly up to Vancouver in a couple of months to purchase the drug for $63.00 because evidently the pharmaceutical company is jacking up the price here in the United States but not in Canada. The pharmacist confirmed that I will be flying to Vancouver. This post is also meant to provoke my Readers' insurance questions, all of which I'm going to compile into some sort of document and then try to find the answers to them, collectively (not socialist, but collectively).
So, Reader, do you have any questions about your insurance coverage and/or what you might expect as we move forward with the lumbering Affordable Care Act? Feel free to rant a bit about the fact that we don't have universal health care coverage in this country, and if you live in one of the many states that are refusing to enact health care exchanges or implement the ACA, leave a rant here, too. And if you're one of those people who thinks we're all lazy bums for wanting universal healthcare coverage, you can just keep googling "big guns," and "right to bear arms" and click right on off this page.
We have our own posse, and it's growing.
How is it that Anthem can farm out their drug coverage to another company (such as Prime Theraputics) to determine what drugs are formulary, non-formulary, covered and not covered and that company in turn tell us we must buy certain medications from a subsidiary of themselves (such as Triessenct) or they will not be covered? And why is it reasonable for said company to only allow one drug in a category to be formulary (for which they may get a discount from the manufacturer at their own pharmacy) and require all other drugs in that category to have lengthy prior approval from physicians and the copay by 2/3 more when all drugs in the same category do NOT work for all patients? Profit for all involved fuels this practices but it is not ethical and should not be legal, imo. It forces some of us to go to great lengths or choose medications over groceries.
ReplyDeleteEXACTLY.
DeleteHave you seen these archived approval letters from Anthem/BC-BS?
ReplyDeletehttp://dravet.org/sites/default/files/Private%20Insurer%20Approval%20Letters.PDF
Not sure if these would be helpful in your appeal to Anthem for Sophie...
Thank you, Hopeful Mother! Those are very interesting. The trouble with clobazam, now, is that it IS covered under Anthem (I got it for years from Calgor Pharmacy and paid out of pocket)but it's not on formulary AND it costs more than ten times what it cost when I bought it WITHOUT insurance. I just have to work very hard to get Anthem to add it to their formulary -- work that I've done before and just shudder to think of doing again. The comment from Ang':sGot Moxie above is EXACTLY what is going on.
DeleteI have no idea why my name show's up that way in comment's. It is actually Ang's got Moxie but gets translated to the garble. Sorry about that.
DeleteI'm having the same issue with Anthem and my own biologic or anti-TNF medication. It had always been covered as formulary and I could purchase it anywhere until they made the switch to Prime Theraputics. It took 6 to 8 weeks for approval and now costs me 3 times as much. It was even suggested to me that I use the drug they wanted (to which I am allergic) rather than the one my doctor prescribed. Because the medication is covered, and we are working middle-class people, there is no other assistance available. In my case, the drugs cost the same unless the company is getting a discount from one Big Pharm and not another. When I appealed to Anthem, I didn't get anywhere because it was all directed back to Prime.
I have no questions for you, only support and love and light and extra patience in case you run out. I don't know if I can help with the trip to Vancouver at all, but I do only live a couple of hours' drive from there, so it's possible I can do something.
ReplyDeleteWe lazy bums in Canada will welcome you with open arms when you come up here to visit our pharmacies!
ReplyDeleteI paid an extra $99 when I bought my laptop and I get unlimited training from all those hip young people at the Apple store. I ask questions and they answer them. It is an extremely satisfying experience. That pretty much describes my insurance fantasy. There is a room filled with energetic young insurance experts. They sport tattoos and gauge earrings. And wear genius signs around their necks.
ReplyDeleteBrilliant comment, Noan. I love it.
DeleteI don't know why there is so much fear and resentment regarding our country's move towards universal healthcare- do people really think they system we have now works well? Do they think things will get worse? I too live in California and am continually amazed by the number of people who don't support a move towards universal healthcare.
ReplyDeleteCompassion, people, have compassion for your fellow human beings. Everyone deserves access to healthcare and medications that will help them live long, happy, and healthy lives.
I'm sorry for your struggles with the insruance company. I have been there too with my own medication. I ended up getting it shipped for less than half the cost from Canada until my own insurance covered the medication.
Eeeeck. I can't think about this too much. It is extremely upsetting. I'm sorry for your struggles. I hope Vancouver is lovely when you visit.
How can this be? How can this be? This is the question that circles in my head when I read these insurance posts of yours. How can this be? Do we want the families of those who need these drugs dragged to the poor house? Do we want the people who need the drugs NOT to take them? How can this be? I think it's time for another Extreme Parenting Video project about the drugs children need that their parents suffer dearly to afford. Go viral.
ReplyDeleteIs your state Insurance Commissioner any help in this? What about your elected rep? Can you take this situation to the media?
ReplyDeleteWe have insurance through my husband's employer (he went to work for them 10 years ago, giving up his own painting business because we couldn't afford the self-insured rates any longer. He is grateful for his job and works with nice people, but he loved being self-employed and it was heart-breaking for him, in many ways, to close the doors of a business he had built himself over a 20-yr period.)
ReplyDeleteWe currently have United Healthcare, which is also currently in a dispute with almost all our local hospitals and many of the doctors as well. This means no access for thousands of people in our area, who are insured. They have to go to a doctor they don't know (good luck getting an appointment when you're actually sick) or, perhaps, a hospital that IS on their plan to see a strange doctor. My daughter just got a letter from her gynecologist stating that they are still on United's plan, but the hospitals where they have privileges are not. This means that their patients who are due to deliver their babies must go to a strange hospital for their deliveries. Who will deliver their babies?
Aetna did this to their customers last year, and it took them several months to re-negotiate the contracts with local hospitals, during which time patients did not have access to care in those areas.
Obviously something is very very wrong, even for those who are fortunate enough to have group insurance through their employers.
just saying i'm here, reading, helping to marshal the force. may it be with you always.
ReplyDeleteI am totally with your posse, but being a Christian in Kansas I sure feel lonely at times. Sigh. I have got to find some local liberal friends!! Helllloooooooooo? Anyone out there? (And I don't want to get rid of my friends or my faith or my husband [ha!] either, but sure would like some liberal friends here close by.)
ReplyDeleteCarrie T. - an apparently lazy bum who doesn't even HAVE any health insurance now and mom of 4 kids all on Healthwave in our state
I've spent $300+ a month for years on a prescription I really need. I have Blue Cross... I just found out that if I get the Rx from their mail order pharmacy it costs $40 FOR THREE MONTHS WORTH. Argh! I wish I'd known this years ago! I wonder if it is the same for clobazam? The local CVS pharmacy was stunned at the difference in price.
ReplyDelete