Anthem Blue Cross Film Noir

The Almighty Anthem Blue Cross has evidently been hacked, perhaps by the Chinese, and more than 80 million subscribers' personal information leaked. Twice in the last year, we've received Explanation of Benefits from Anthem Blue Cross of Georgia denying claims for Sophie. While Sophie used to have a policy from Anthem Blue Cross of California, we've never had one from Georgia. The dates on the claims are from years ago, and the first time I got one, I just raised my fabulous eyebrows and threw it in the trash. I got another one yesterday, and coupled with the news of the hack, I wondered if somehow, somewhere, someone is impersonating Sophie. Under the eyebrows, I'm imagining the ease with which some other Sophie is purchasing wheelchairs, orthotics, obscure anti-epileptics, rectal Valium and the like. I'm amused by the thought of someone taking Sophie's identity and being subject to Anthem Blue Cross of the World.

Good luck with that.

Cannabis Oil Questions Answered #3

How does Sophie take Charlotte's Web, and how much does it cost?

A lot of people don't realize that Charlotte's Web is a tincture with an olive-oil base and that it's easily drawn up in a small syringe and placed in the mouth. It tastes like olive oil with a faintly bitter tint, but I'm what you call a super-taster, so I imagine Sophie doesn't taste much of anything. The doctor recommends that it be given with either avocado or full-fat yogurt, but we don't always do this, either, as it's given three times a day, apart from Sophie's other medications. She gets it in the early morning, in the afternoon when she gets home from school and then around 10:00 at night. For the last dose, she's usually sleeping, but we're able to get it in her mouth without waking her up, and I've perfected the art, even, of getting her to swallow by rubbing her throat lightly or the sides of her face. I know that people give the medication through G-tubes, too.

As for cost, currently we pay $.05 per mg. I am averaging about $300 for a one-month supply. I know that's a lot of money, but to put it in perspective, I currently pay nearly $200 in co-pays for Sophie's medications, not counting the pharmacy deductible, and that's with private insurance and secondary Medi-Cal. Some of you long-time readers know that my co-pay for Onfi was nearly $500 a month until I got it from Canada for $61 and then found a non-profit foundation that picked up the co-pay. When we finally shed our abysmal Anthem Blue Cross policy and added Sophie to our Health Net plan (thank you, Affordable Care Act), we had to pay a slightly higher deductible, but they added Onfi to the formulary and picked up a greater portion of the Onfi cost (still hefty at $70). I pay $100 co-pay for the Vimpat. And we can't forget that those drugs do nothing for Sophie's seizure disorder, have horrible side effects and are a hellacious pain to wean.

I think I've said it before, but there's not much that I wouldn't do to come up with the money to pay for Charlotte's Web, given that it has cut Sophie's seizures down by more than 95%. You can go with that where you will.

Questions?




Other Cannabis Oil Questions Answered:

# One
# Two

Clusterf*$%kery, part 4,345,678

Despite all the recent excitement with the press beating on my door as I attempt to muddle through the clusterfuckery that is The Cannabis System, we need to get back to our regular programming. I just spent the last 15 minutes on hold with Medi-Cal and then 45 minutes in conversation with a very helpful, very clueless gentleman at Medi-Cal. You might wonder how someone can be both very helpful and very clueless? The ability to hold opposing thoughts and ideas in unison -- equanimity, if you will -- is a skill I've perfected over the last couple of decades (ok, to be honest, it's only happened in the last five years or so), as is the very careful walking of the tightrope, swinging from the trapeze and other grand carnival acts.

So, you can take my word that the gentleman I spoke with on the telephone was very helpful and very clueless.

I called because as of February 1st, Sophie was added to our health insurance policy (Healthnet), and we dropped her Anthem policy. Sophie also has Medi-Cal, which is secondary to her private insurance, but at present, Medi-Cal is LINKED TO ANTHEM. I called Medi-Cal (my fifteenth attempt, I should add) to ask them to:

1. Drop Anthem Blue Cross 
2. Add HealthNet
3. Link Medi-Cal to HealthNet

My aim is to ensure that when medical claims are filed with HealthNet, Medi-Cal picks up the uncovered stuff, LIKE IT'S SUPPOSED TO.

Well, the helpful but clueless gentleman informed me that I needed to fill out form -- let's call it AGNES because I don't want to stress you out further with the amount of numbers I'd have to type out to indicate which form -- proving that I was indeed authorized to act as Sophie's conservator. In other words, since Sophie is over 18, her privacy is protected and Medi-Cal can't authorize the release of information. If you remember the other, now distant clusterfuckery that was gaining Conservatorship, I am officially Sophie's conservator (in addition to being her mother). God forbid this sort of snafu should have been taken care of back then with the Social Security office. He very helpfully directed me to Form AGNES but upon perusal of it, he decided that it was maybe Form GLADYS that I needed. He then directed me to Form GLADYS, and we both realized that Form GLADYS was actually the wrong form, so we moved on to FORM MILDRED after he checked with someone.  

Form MILDRED it is, and I was instructed to fill it out and send to the address at the bottom of the form. I said, There is no address at the bottom of MILDRED, and he said, Oh. Let me go and see where you send her. 

And I said OK and then I did a little pirouette on the high wire and smiled down at the admiring crowd. When the helpful but clueless man came back on, he gave me an address and thanked me for my patience. I now must fill out MILDRED, send her to Sacramento, hope that she is received and processed, upon which I will call back Medi-Cal to request that they do Numbers 1 and 2 above.

Did you get that?

I'd really, really appreciate if you, dear Reader, moved that net right under me as I do believe I might be plunging to my death at any moment.

What I look like when I'm on hold with Anthem Blue Cross, part 45,234,965

Ya'll, the tentacles of the great and almighty Anthem Blue Cross are still wrapped around me. As some of you know, our relationship is rocky at best, a desolate wasteland, at worst. I have been trying to extricate Sophie from the grasp of the beast for nearly two months -- via telephone, regular mail and then certified mail. I resorted to calling that other beast -- The Bank -- to cancel automatic payments to Anthem. Still, the bills came and today's even had $50 of interest tacked on to the warning that coverage would be terminated after interest and premiums were paid.

What the hey?

The Anthem Computer Man led me through the labyrinthine halls and into a windowless room where I was told that my wait time would be twenty minutes and the sweet, sweet strains of Bach played. I started typing. An Anthem Human Man came on, lo and behold, after twelve minutes and spoke gently. I don't see any letter stating cancellation, he said. Of course you don't, I said good-humoredly. The Anthem Human Man made some gentle entreaty about HIPPO laws (and yes, I know they're not really hippo laws) and I explained that my daughter, the said Sophie, the MEMBER, was my severely disabled daughter and that I spoke for her as she couldn't speak. At all? the Anthem Man asked. That's right, I answered. You'll notice that all communication regarding her account has my name on it as well, I added.  He went to check the hippo pond, gentle strains of Bach came through the speaker, I tapped my red fingers, wondered how deep the mud was in the Anthem hippo pond and contemplated the universe.

The Anthem Computer Man is taking care of things right this very moment, as I type. Bach is still playing.

Thank you for your patience, he whispered in his reed-thin voice, and I slithered out from under his arm, the last sucker -- pop.

The Anthem Bonfire Party

February 1, 2014

Dear Customer Service,

I have made repeated attempts to get in touch with you regarding my daughter, Sophie XXXX's  Anthem Blue Cross membership, but I have been unable to get through to a human for some time. I understand how busy you’ve been with changes because of the Affordable Care Act, and I am taking this opportunity to inform you that Sophie will no longer be a member as we have decided on a different and better health plan for her and for our family.

Please cancel Sophie XXXX's membership. Her ID number is XXXXXXXXX.

I will also take this time to let you know that our affiliation with Anthem Blue Cross has never been anything but a frustrating nightmare, that you have caused great anguish and stress for our family over the past decade and that we are beyond thrilled to be rid of you. I can only hope that your company will learn to be as ethical as you are profitable, but I imagine these are high hopes, indeed, and I don’t pretend that a small customer like ourselves will make much difference leaving your business.

Sincerely,

Elizabeth Aquino

What I look like when I'm on hold with Anthem Blue Cross during its death throes

So, a while back I posted what I look like while I'm on the phone with Anthem Blue Cross and eating a breadstick instead of smoking a cigarette. You can refresh your memory here. Today, I tried for the fifth time to contact Anthem in order to remove the automatic withdrawal of Sophie's premium from our checking account. I'll remind you that the evil and disastrous Affordable Care Act (that's sarcasm, there) enabled us to finally add Sophie to our health plan, and in doing so we are getting an entirely new health insurance plan with  entirely better benefits with an entirely different company for an entirely better price. Sophie used to have her own plan, an abysmal one, whose premium had been jacked up over 100% over the last few years and was diligently removed from our checking account by Anthem each month. The rest of our family had a separate individual policy with Anthem, equally as abysmal with an even greater rate of jacked-up premium, and we paid that one by check each month.

Anyhoo.

I've been trying to cancel the automatic withdrawal of Sophie's payment for weeks and have not been able to get through to a customer "service" agent. When I was connected to a human service agent -- ONCE -- I was sent on one of those hellish odysseys through the windowless warrens of Anthem and finally landed behind door number 6,345,876 and told to hold. Again.  The picture above was taken during that hold time, and in lieu of a bread stick, I kept a pen in my mouth and rolled its smooth, cold chartreuseness in my mouth while listening to many, many bars of a requiem that I imagined was for the death throes of Anthem and its connection to my family. My normal appreciation for classical music reached a breaking point, though, and when a voice finally broke into some seventeenth century dirge, it told me that due to the Affordable Care Act, we are unable to help you with your problem. Please call back at another time. In lieu of chewing on pens or smoking bread sticks, I went for the rectal Valium that Anthem has so kindly allowed us to purchase at a reasonable price.

Just kidding. That would have been an unauthorized usage of a powerful narcotic. We prefer weed over here.






To make a long story short, I have contacted my bank and put a stop to the automatic withdrawals that way. On February 1st, when the new policy goes into effect, I will be walking through the streets of Los Angeles with a burning blue cross. If anyone would like to join me, please do. There will be bread sticks and rectal Valium.

Morning Light

I'm doing the final filling out of the new health insurance application, and we're actually changing providers! We're paying a bit more but getting vastly different coverage, can also drop Sophie's measly plan, add her to ours for the first time in nearly a decade, have her prescription drugs covered at a reasonable rate and feel a modicum of ease that if any of us should have the barest hint of illness or disease, we won't go bankrupt paying for medical care.

I am so excited about cutting off Anthem Blue Cross and switching providers. I might have a bonfire and burn something in effigy!

Please stay tuned for the festivities planned. All suggestions welcome.

Where parenting, politics, disability, poetry and politics intersect

So, yeah, go ahead and complain to me again about a (temporarily) glitchy website. Fact: many historic American achievements have been preceded by mistakes far more harrowing than a flummoxed website.

Bob Cesca (read the full article, here) 

In all this talk of miracles and healings, with postings of poetry and naked dancing, I haven't spoken too much of politics lately, except for the occasional jab at the difficulties we are facing in the epilepsy community with getting medical marijuana for our children and the draconian federal policies governing it.

So, where's the politics at a moon, worn as if it had been a shell? Now's the time for those of you who abhor them to click off, drop away, go back to your peaceful day. I'll give you a sec.




Peaceniks and Tea Partiers gone?

OK.

I want to talk about healthcare and the Affordable Care Act or Obamacare, particularly all this brouhaha over cancelled policies and the POTUS lying about it and the government comin' between me and my doctor (thick southern accent here, please) talk, etc. etc. First of all, there aren't many people who supported healthcare reform who weren't disappointed in how the Affordable Care Act shook out. Those of us in the individual insurance market who had any sense at all were perfectly aware that the Obama administration compromised mightily with the insurance industry in order to satisfy not only that Evil Empire but those who rattled their sabers about socialized medicine, about the slippery slope to European style government and hell and damnation. The Affordable Care Act was a HUGE compromise and far less than the universal coverage most of us on the "left" had hoped would happen. I perhaps cynically don't believe that real universal coverage will ever happen in this country because we're not sophisticated enough, as a rule. I'm in the group that believes the ACA made some monumentally positive changes, though, that will improve the lot of tens of millions of people, including our family.

Yes, we were one of those families that got the letter from Anthem Blue Cross stating that our policy would be terminated as of January 1st, 2014 because it was out of compliance with the law as outlined in the Affordable Care Act.

Let me translate that for you:

We at Anthem Blue Cross will no longer be able to provide you with one of the shittiest, most expensive health insurance policies that we offer because if we do, we will have broken the law. We can no longer deny that you add your epileptic daughter to your policy. We can no longer cap out our expenditures in the event another member of your family develops a disease or has an accident warranting millions of dollars of healthcare. We can no longer deny coverage for preventive care. We can no longer force you to pay ever-increasing premiums that buy you catastrophic health care ONLY. In fact, this shitty policy for which you've paid tens of thousands of dollars over the last nearly twenty years of your life only proved to us that you were as stupid and lemming-like as we could have hoped at the time. That time, sadly for us, is over. BUT, we're happy to inform you of your other choices, which might cost you more but be of improved value. 

Now, I'm as nervous as the rest of you, but I've been on the California website and have figured out that our family might qualify for a federal subsidy so that our monthly premium won't be as high as it is now. I've also figured out that if it is higher than what we pay now, it will be far more comprehensive with far more choices, and most importantly of all, Sophie's shitty policy can be cancelled and she can be added onto our own. I still think the Evil Empire (insurance companies) make out like thieves, and I still believe universal healthcare should be the rule of the land, but anything, anything is better than what we have now, and the ACA appears in many respects to be an improvement.

Now, I'm tired of typing. Read this article.

Tell me what your experiences have been.

Just in Case (this post brought to you by The Corporation for Long Simmering Anger Some People Carry Toward Anthem Blue Cross)

For every claim that I receive in the mail, statement of benefits or denial of benefits or bill for premiums from Anthem Blue Cross, I also get a sheet of paper that offers Language Assistance Services. Is this just in case a member of our family, even Sophie, might suddenly gain fluency in a language other than English? The fact that Anthem has the capacity to offer its estimable (questionable) "services" in English, Spanish, Chinese (Traditional), Korean, Vietnamese and Tagalog is secondary to the fact that we have never requested Language Assistance despite more than a decade of "membership" in that estimable health insurance company. If I were a math nerd, I'd figure out what one piece of paper costs and then multiply that cost by the approximate ten thousand sheets of Language Assistance Services paper that I've received over the years and then I would compare it to the ten thousand premium increases I've received "due to the spiraling costs of healthcare" and then I'd see if we're even. I'm not a math nerd, though, but rather a poetry one, so I'll just remark on the beauty of those Chinese (Traditional) symbols that hearken back to my days studying the language in college, the better to understand Li Po and Tu Fu. Then I'll throw it in the recycling bin where eventually it'll join its brethren in some giant dump before being churned out again.

How I look when I'm on hold with Anthem Blue Cross

I'll blame the jowls on them, too

and the dark circles.

Yesterday's joust with the most loathed company in America came about because I wasn't properly reimbursed for Oliver's recent twelve year old check-up. Evidently, the doctor had checked off the Age Range 12-17 box on the diagnostic code list, and the Date of Service was May 9, 2013 which made Oliver 14 hours younger than Age 12 (he turned twelve on May 10th) and therefore not reimbursable because he was STILL ELEVEN AND NOT YET TWELVE. Got that?

I'm not kidding you, folks.

After that phone call, my jowls hit my cleavage, and there they swing.

Easter, Anthem, Manna from Heaven and Paradox

what I imagine Anthem Blue Cross headquarters to look like

Are you sitting down?

I received the following notice in my inbox this morning:

Your rates may be reduced and you could get a refund.

We have reached agreements with the California Department of Managed Healthcare and the California Department of Insurance to lower our average Individual rates. This agreement does not impact our California HIPAA and Conversion plans and policies

That means your rates may be coming down soon! We are currently recalculating the change to your medical premium and potential refund. We expect to have the new rates finished, filed and updated in our May billing cycle. This information will be provided to you soon.

If you cancelled your coverage after receiving the notice of your rate change, you will be given the chance to reactivate your Individual health benefit plan.

We value your membership. More information will be mailed to you in the coming weeks.

I was just thinking that since I left the Catholic Church, celebrating Easter seems hollow and a bit depressing. I haven't quite figured out how to celebrate its message of love renouncing death, but perhaps this email from Anthem holds the answer -- either that or bunnies really do hop around with baskets of colored eggs and chocolates.

Big, Long F**ing Sigh (and a bit of a rant)

from Anthem Blue Cross, dated 17-Jan-2013:

Dear SOPHIE,


We would like to follow up regarding the grievance referenced below. We appreciate your taking the time to express your concerns to us, since it is through such communication that we are able to continually improve the quality of service that is provided to our customers. 

Please be assured that the issues you have brought to our attention have been reviewed and appropriately addressed.

Anthem Blue Cross (Anthem) received a grievance regarding the non-formulary status of the prescription drug Onfi. The grievance requests that we add the drug to the formulary, since it is a very expensive medication. You are now forced to go to Canada to purchase it at a reasonable price, and your doctor has included a letter of necessity.

I can understand your frustration with the classification of your prescription. Unfortunately, Anthem is unable to alter the terms of the plan for any one member. If you wish to take a medication that is non-formulary, you are certainly permitted to purchase this drug.

...

The Onfi prescription is expensive and there may be only a limited number of members who use this drug. Anthem regrets that at this time it will continue to be considered non-formulary. 

...

[Blah, blah, blah]

Sincerely,

BRENDA H. SKALA
G&A Representative
Grievance and Appeals Department

Well, I guess my next step is to request that the drug be "reviewed for formulary consideration at the next quarterly meeting." I'd love to call up Ms. Skala and give her a piece of my mind, but why bother? She's probably not even a real person.

I've beaten the dead horse on this one, folks, over and over. Who the hell are these people? Why, why, why don't we have universal health coverage? Why does an insurance behemoth constantly come between us and our doctors? Why are the obscene profit margins of insurance companies not more roundly denounced? Why does a drug cost Sophie $63 a month in Canada and $990 in the United States? The same drug? Why? Could there possibly be millions of children in Canada who are on the drug and thereby the price is lowered due to demand? Why is Sophie not entitled to a medication that helps her at a reasonable price? Why do people object to entitlement when it benefits a seventeen year old disabled young woman who has grand mal seizures twice a day every single day of her life? Why?

What I look like when I'm talking on the phone with an agent of Anthem Blue Cross

while eating a breadstick instead of a cigarette.

I got our premium bill in the mail today, due February 1st. I noticed that the amount due was considerably higher than my last payment (for January) -- exactly 24.89% higher. I remembered reading back in October that Anthem was hiking rates for individual policy holders up to 30%, and I think I did my usual ranting about it, but when we didn't get a notice, I was relieved. For once, I thought, we got a pass.

Evidently not.

I quickly called Anthem and filed a grievance. I told the unfortunate agent that I believed they were out of compliance in not notifying us of the rate increase within a reasonable time. The Unfortunate Agent told me that I had been informed. I took a long drag on my breadstick. I said that I had not been informed and so it goes. I filed an oral grievance on the phone with her, and when I asked her for a written copy of the letter they claimed to have originally sent, she claimed that she would speak to a supervisor about it. I took another long drag on the breadstick. She also said that she would file my grievance and that I would be notified in 30 days that it had been filed and a "decision" would be made 30 days after that. I told her there is no "decision" to be made, and then I asked her for a written copy of the grievance. She told me that she couldn't give me anything but a tracking number. I took yet another drag on the breadstick. I asked her for the number of the California Insurance Commission. She gave it to me, and then asked me if I needed anything else. I told her that I felt sorry for her having to work for such an unethical business, and she asked me, again, if I needed anything else. Bless her heart.  I placed the call immediately to the California Insurance Commission and had a lovely chat with the Fortunate Agent who told me that she was hearing about these rate increases and the lack of notification about them. She told me that she would call me tomorrow morning with an update and when I asked her about Sophie's drug problem, she told me that she could help me with that, too.

I finished my bread stick and called it a day.

Joan of Arc, Drug Mules, and Guns

Joan of Arc at Prayer, John Everett Millais, 1865

Some say that Joan of Arc, or Saint Joan, received her visions directly from God. Others say that Joan of Arc might have had temporal lobe epilepsy and with it came the intense and revelatory hallucinations that directed and guided her to save her people. I don't know, but I imagine that in every way, Joan of Arc was guided by Love, a godly Love -- something divine and certainly other-directed. I was thinking about Joan of Arc and her visions and her epilepsy while I was taking a shower this morning. I was also thinking about the little card I got in the mail the other day along with the letter to Anthem Blue Cross from The Neurologist. The card was a discount card from the manufacturer of clobazam, the drug that The Friend Who Loves Jane Austen recently ferried across the great Canadian-American border for me. The letter is part of a larger grievance against Anthem to add the drug to Sophie's covered formulary so that it's affordable. The little card gives the user a $50 discount monthly up to a year for the drug, and I wondered whether the drug manufacturer thought itself kindly or cooperative in making this gesture. I thought how the nearly $1,000/month price it charges in the United States compared to the $63/month price it charges in Canada suggested that only the proverbial 1% could afford the drug. The rest of us are supposed to be grateful for the discount. When I stepped out of the shower, the aroma of the gingerbread cake I'd put into the oven wafted through the steam in the bathroom, and as I toweled off, I thought of Joan and her visions and her epilepsy and her zeal. I thought of the families, again, in Newtown, one of whom is dear to me, and I thought of the people who have rushed, with zeal and fear, to buy up guns much like the ones used to slaughter little children, before they are, perhaps, out of reach.

Guns, I thought, for the free and the brave.

Quelle rackette, Joan of Arc might have said, as she climbed on her horse and drew her sword, her eyes directed outward, her brain's marvelous mapping obedient to the Divine.

Drug Mule, Part 5,467,890, Oliver's Music Concert and Elementary School Shootings

So that's Oliver in the middle there, looking all sweet and ready to sing at his school's Winter Holiday Concert. The concert last night was the highlight of my day and a balm to the soul, as I spent most of the morning and some of the afternoon on the telephone with Anthem Blue Cross and then with My Canadian Boyfriend, the pharmacist in Vancouver, and then my Jane Austen Lover Friend in Vancouver who will be performing drug mule duties today and bringing Sophie's medication to Los Angeles this weekend. Who knew there was such excitement to be had in the world of Big Pharm/Big Insurance? If you're really into this stuff, you can go back and read my drug mule posts, here and here and here. Actually, there are about ten posts that refer to drug mules, and I can't vouch for their being interesting or exciting, but yesterday, as I tried to figure out what was going on with my grievance against Anthem, I thought of this photo that I posted years ago on this blog as an example of where I believed the Anthem Blue Cross Review Panel did their diabolical work:

In one of the inane conversations I had with one of the pathetic clerks that work in this office, I asked whether Sophie's drug had been added to the formulary, yet. The Pathetic Clerk typed away and told me that the Drug Review Panel met quarterly to decide what drugs to add to the formulary, and that the decision had already been made for January 2013 and that no, Onfi was not on that list. I asked The Pathetic Clerk  how I might reach the Drug Review Panel or how my doctor might reach the review panel, and she said, I have no idea where they are and how to reach them. We are not given authorization for that sort of information.

I began to weep profusely, then, and curse the heavens.

Just kidding. I felt my heart beat quickly and let off steam by sympathizing with The Pathetic Clerk, telling her that I couldn't imagine working for such a diabolical company. She laughed and when I hung up, I actually did shed some tears before I went into action, called The Neurologist and My Canadian Boyfriend Pharmacist, arranged to purchase the drug again and then called My Friend J who referred me to our mutual friend, The Jane Austen Lover who lives in Vancouver but who is traveling to Los Angeles this Saturday and who will be picking up the medicine from said pharmacy and bringing it to us. I made a copy of Sophie's birth certificate and typed a letter authorizing this drug transaction should customs officials question The Jane Austen Lover and emailed the appropriate documents.

Then I went to Oliver's concert.

This morning, I woke up to read the news of another elementary school shooting, this one hitting very close to home as a good friend and former blogger who is now blogging again, has two children at the school. Thank the good heavens that her kids are now safe at home, albeit traumatized, but I can't help but wonder why in the hell one is able to go online and order hundreds of rounds of ammunition in this country yet have to go to ridiculous lengths to get a 60-day supply of medication for one's epileptic daughter.

Calling on the Posse, Part II

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.

Calling on the Posse

I just read that Anthem Blue Cross is preparing to raise rates up to 25% for its independent subscribers. Sophie has an independent policy with Anthem Blue Cross, separate from The Husband, who carries the boys and me on his. I'm not sure people realize that despite the terrific improvements of the Affordable Care Act, it didn't do much to address the serious problems that those with independent policies have in affording them. Basically, Big Insurance and Big Pharm kept all the perks and continue to rake in the profits at our expense. It does look like California is addressing this latest travesty, but God forbid we should have universal healthcare coverage, or what the right calls socialized medicine ( I think I'll take to my grave someone I heard with the thickest redneck accident saying pre-Affordable Care Act that she didn't want no government comin' between me and my doctor.

I guess the 630,000 individual policyholders here in California, including Sophie, Henry, Oliver, The Husband and myself, need to get off our lazy asses and work harder.

I'm more inclined to raise a posse.

How about you?

A Read-Along Picture Book with Drugs

Today, I went to Rite-Aid to pick up Sophie's prescription for Onfi, also known as Clobazam. I used to get the drug from a pharmacy in New York City that got it from Canada or Germany. I used to pay $150 or so for a six week supply. I paid in cash because Onfi, or Frisium, as it used to be called, was NOT covered by the United States Federal Drug Administration. Sophie's neurologist faxed a prescription for the drug to a pharmacy in New York City that waved some sort of magic wand and flew me the drug after I'd charged it. It was all legal.

Clobazam or Frisium, the way it used to be packaged

Clobazam or Onfi, the way it's now packaged

In January of 2012, the FDA approved the use of Clobazam. Manufactured by Hoechst, the drug Frisium is manufactured now by Lundbeck and was renamed Onfi. It was immediately available at my local Rite-Aid.

Great! I thought. Now Sophie's private insurance plan will cover it.

Sort of:

Sophie has her own medical insurance, administered by Anthem Blue Cross. It's an individual policy, and she has Medi-Cal as a secondary policy. Her premiums have increased over 75% in the four years she's been on this policy. The drug deductible is $250 and co-pays for most medications run about $30.

Onfi is not on Anthem's formulary and therefore is reimbursed at a lower rate than Vimpat -- let's say -- which costs $30 per month as a co-payment. It appears that Onfi costs $990.99 for a one month supply, approximately $890.99 more than it did in 2011 when I bought it from another country. Anthem Blue Cross is picking up $600.75 of that cost. Medi-Cal will not cover any of it. I have a coupon from Lundbeck that gives me $50.00 off for 12 months, leaving me a balance of $340.24. 

Here's the picture, again:

 Do you follow me?

This is actually not me but Ellen Burstyn in the frightening movie about drug addiction Requiem for a Dream.

Good. Let's move on.

Last time this happened to us was with the drug Vimpat, an anti-epileptic that was also recently added to the arsenal of drugs used by those with epilepsy. It took me approximately two months to file a grievance, call the Epilepsy Foundation of Greater Los Angeles (thank you, EFGLA!), wrangle a letter from my swamped neurologist attesting to the medical necessity of the drug, in case we were just fucking around with new drugs and Sophie and then finally my assemblyman who had some sort of pull with the insurance commissioner who then must have made a call to Anthem, because one day when I went in to pick up Sophie's Vimpat, the pharmacist told me that the cost was $30, not $425 like I had been paying up until that moment.

I honestly don't have fat fingers, although they look very fat here.

This is the sort of thing I think about when I hear the other side claim that they don't want the government coming between me and my doctor. 

Let's move on.

 I've been paying/charging $340.24 for the Onfi since January because I made an initial attempt to persuade Anthem to add it to the formulary, was promptly stonewalled and then I just -- well -- gave up. 

Even Dragon Mothers can't do it all, all the time.

Sometimes, it's all too much.

Today, after paying for the Onfi at the Rite-Aid, I felt the old surge of righteousness, and when I drove home, I got on the phone and called Anthem to inquire whether they suggest I go through the whole process again. I was put on hold, listening to Journey for approximately seventeen minutes.

The clerk who finally answered the phone tapped away on his computer for many minutes and confirmed that, no, the drug Onfi is not on the formulary and won't be until Lundbeck the manufacturer lets their patent expire.

My similarities to Ellen's character's look abound.

I thought, why would the drug manufacturer charge me $150 in cash when the drug came from Canada or Europe but now charge $990.99 in the United States, have Anthem eat $600 of that and charge me the rest and then give out $50 coupons to be used for only one year?

I said, Oh.

I do believe this is another time for my favorite vintage photo of all time:

The efficient clerk from Anthem told me to file a grievance, the form for which he would send me via email.

Is there anything else I can do for you today? he said.

Uh, no thank you, I said.

to be continued at some later date

Special Needs Ryan Gosling Friday

Make your own Special Needs Ryan Gosling by going to Sunday's blog Adventures in Extreme Parenting and linking up.

A Morning Anthem

I got an email from Anthem Blue Cross this morning that looked like this:

Your Healthy Solutions Newsletter Has Arrived!


It was the exclamation point at the end, all the cheerfulness inherent in the teardrop and pinprick that got to me, and on a day where I'm hard up to find inspiration for writing (the weather, again? Sophie's seizures, again?, the Transit of Venus, again? the arguments between my sons on whether or not they'd seen the transit because aren't you blinded, Mom, if you look at the sun?), well, caustic words toward Anthem might be just the thing.

I think it would be downright refreshing if Anthem Blue Cross would change their marketing and advertising communication techniques and just be honest. At the very least, I would get a laugh and at the most feel a grudging respect for honesty were that subject line in my email to look like this:

We're Busy, Working Hard to Ensure That We Screw You With Increased Rates!


Or maybe something like this:

Our Intent is Not To Give You As Much Stress As Your Daughter's Seizures, But To Make As Much Money As We Possibly Can!


Or maybe something like this:

If the Supreme Court and Republicans Overturn the Affordable Care Act, We're Ready to Really Fuck You Over, So Be Prepared and Get Healthy!


Or maybe even this:

We Look Forward to Continuing Our Long-Standing Relationship of Coming Between You and Your Doctor On All Matters Related To Your Health!


Reader, if you'd like to join me in this campaign for honesty in advertising and marketing, please feel free to leave a comment. Curse words are welcome. Heck, you can even curse me! And don't forget the exclamation point!