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What's annoying you today? Part 2


WithLove

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At work today (in a pharmacy) a patient came to pick up a prescription for their child. The kid got the same prescription a few days prior for an illness, but vomited shortly after the first dose (after all, the kid was sick). We told them to give the dose of medication again, but as a result they didn't have enough of the medication to complete the full course. Got a new prescription from the physician, but insurance won't cover the same drug for the same patient in a short period of time. I called the insurance company to explain the situation and ask for an override so the parent doesn't have to pay the full price.

 

Me: (explaining the whole situation to the insurance)

Insurance: So you're asking for an override?

Me: Yes

Insurance: What is the override code?

Me: I don't know what codes you use?

Insurance: We need the code to override it

Me: Well what codes are there? Maybe I'll know it when I hear it

Insurance: I can't tell you that

Me:

 

I understand why they wouldn't cover it if the patient was careless & lost the medication. But it's not exactly that insane to think that someone taking a medication for an illness would vomit after a dose due to said illness. Isn't this what insurance is for?

 

Also, I hate the new year with all of the insurance changes & hundreds of dollars in deductibles that people have to pay. An elderly patient came in to pick up prescriptions for their spouse, and I saw that one of them was a couple hundred bucks. I asked for an insurance card to run it for them, and they said they somehow didn't realize they weren't signed up for insurance any longer. They actually paid over $200 for a one month supply of a medication. It twisted my gut a little. I feel so bad for elderly people on a fixed income who are taking all of these medications (some not available as generic) and are just paying a crapload of money each month. It's just not right.

 

Bless you, Alli, for this post. People like you in the pharmacy give me hope. I'm dealing with my own insurance/medication issues right this moment and it's so hard. I just want to break down and cry most days over it, because I live alone and there's no one to help me. Hearing how you went out of your way to help that family with the sick kid - It makes my heart smile.

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I had to spend an hour on the phone today with someone to explain to them why if they have to explain what they wrote, instead of just writing it in the first place, then maybe they should go back and do a rewrite instead of getting mad that people didn't like what they wrote to begin with?

 

Sigh, this is a new client and I'm not sure it's going to work out.

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Thank you Obamacare. Brought to you by the idiots of MA where it started and doesn't work for crap.

 

Amen to that. My mother has "good insurance" and yet getting anyone to cover her hearing aids is a major battle and will have to come out of pocket to the tune of several thousand dollars. Like she doesn't need to hear or see, so no one is going to cover that. It's a luxury. And in the meantime she slips further away mentally, because now she can't hear what's being said, so she just tunes it all out and has stopped making eye contact unless someone reaches out and touches her hand and takes the time to speak to her slowly and clearly.

 

Meanwhile I'm still trying to figure out the forms to even get healthcare at all for myself and my son. My non-US friends all laugh at us in the states for even saying we have universal healthcare.

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I pay almost $800/monthly for insurance and have a $2000 IN network deductible and $4000 OUT of network. What? I'll be damned if the idiots who manage my insurance are going to tell me who I can and cannot see when I live in a state that has the top medical facilities available.

 

So...somehow I am responsible for the first $10k of any bills? ?

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I pay almost $800/monthly for insurance and have a $2000 IN network deductible and $4000 OUT of network. What? I'll be damned if the idiots who manage my insurance are going to tell me who I can and cannot see when I live in a state that has the top medical facilities available.

 

So...somehow I am responsible for the first $10k of any bills? ?

 

I hear you!!! But... $800/month?? That's insane. There should be no deductibles or copays. That's why you're paying so much, after all.

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Ugh. I'm struggling so much with my insurance right now already. It makes me want to just cry. I've been to the doctor twice in a month, and I owe them $322! For two visits! That's not even counting the EKG I had, either. My stupid insurance doesn't cover anything at all until I meet the $2,600 deductible... Which looks like it'll actually happen. But I live alone, with just my income. Where do they expect all this money to come from?

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Put me on the list of frustrated insurees.

 

How long does it TAKE, to decide whether or not occupational therapy is a medical necessity? And I've scared and/or pissed off my son's OT because they sent the stuff out 16 days later than they said they did, and I lost my cool a little bit. Now she will only talk to me about 'clinical matters'. Well, SHE is the one who claimed to have faxed it. And I look like a goof because I keep giving the insurance company a date 2 weeks earlier.

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I know insurance can be very expensive, but the good thing is that the law puts a cap on how much insurance companies can actually profit (from what I understand, at least). I can understand why they are so high considering the cost of medical procedures and medications. I see the prices of drugs before insurance covers them. Many are hundreds of dollars for a one month supply. Mainly I notice it now because people have new insurance plans so we fill the prescription as paying cash until the person brings in their new insurance card. So before I have the insurance card, it says they owe something like $150. After I get the insurance card, it says they owe $5. People often don't know how much their insurance company is paying for that prescription that they had a $5 copay on. I saw one this week that was over $1,000. A container of some type of eye drops was over $150. I understand that drug companies have to make a profit off of their successful medications considering the cost of the research & development that goes into each one and the thousands that failed before even reaching the market due to lack of safety & efficacy. Still, the prices just seem so completely inflated.

 

I had one guy run out of those $150 eye drops before the month was up. He said he needed them & would just pay out of pocket until I told him the price. Another drug he had been taking for years was suddenly not covered by his insurance at all. I'm guessing because it's not considered safe for the elderly, so by not covering it I think the insurance company hopes it will push him to see his doctor & switch to something safer for geriatric patients (and thus, save them money later from the cost of covering a hospitalization due to adverse effects of the medication). Still, I felt really bad for him. He came to pick up two medications and he drove away with none due to the cost.

 

I wish there was more visibility each year on the changes in what insurance will cover so both the physician and the patient knew the out of pocket cost before a medication is prescribed & the patient shows up at the pharmacy to pick it up. Sometimes people know, but a lot of times they don't. If both the physician and the patient knew the costs while they were at an appointment, they could decide together what options are best to balance the best benefit with what is most affordable.

 

I guess I'm just rambling. The system is so disjointed with competing interests. I just wish we did this better.

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Man, this guy at work was so freaking rude to me tonight. I still can't stop replaying it in my head. I really, really hate being a bartender sometimes. Basically, he was mad because I wouldn't hook him up with extra alcohol in his drink, so he began insulting my competence and implied that I am not a bartender at some high-end place because I'm not skilled enough. (I've worked at other bars, and have had many compliments on my skills from customers. In fact, I have been told by management on numerous occasions that I am the best bartender at my bar.) It just made me so mad. Also, I know that I didn't short-pour him because I remember making his drink, and I generally don't short-pour people. And then he called me a name! I had to have my manager toss him out.

 

Sigh. I can't wait until I'm done with all my internships and I can quit working in the service industry. What makes it worse is that somehow I'm supposed to stand there and listen to condescension, or name-calling, or criticism, or downright rudeness, and not react. I'm just not zen enough for that. I think anyone would react if a person was questioning their competence. Grrr, I HATE the service industry.

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