A few weeks ago I was prescribed a medicine by a doctor, a medicine I *do* really need. Okay, great: I have insurance that covers prescription drugs. I'm a lucky ducky, to use the Wall Street Journal's preferred term.
Anyway, I try and get the scrip filled. The pharmacy says my insurance doesn't cover this medicine. It's not in the insurance company's "formulary." (The word "formulary" conjures up images of apothecaries in Renaissance villa chambers, surrounded by smoking beakers and alembics.) I cannot pay the $95 out of pocket the medicine requires, so I stomp off angrily without my drugs and tell the pharmacy to keep the medicine.
At home I call my insurance provider. Yep, the med is indeed not in their formulary, they affirm. They say I can get the doctor to sign a "medical exception" form and *then* they might cover it. The phone operator had a tone of, "Oh, trust me, bro, I didn't make this rule, I feel for you, it does suck -- it's these bureaucrats making these rules, not me" (So why can't I speak with those faceless bureaucrats instead of someone who's acting like he's on my side while at the same time reinforcing company policy anyway?).
My doctor sends the company the forms. This is a huge hassle and happens over the course of days. The insurance company responds: Nope, not gonna cover the meds anyway, the medicine insurance co. decides, even after the doctor faxes them stuff and fills out paperwork. Well, fuck. What now?
I called the drug's maker, Pfizer. I've heard they have programs. I don't qualify for any. Finally I am told, after about 4 hours+ of calls to hospitals, etc., to call the number "211." You know how 911 is for emergencies, and 411 for info? I learned 211 is for Dept of Health and Human Services-type issues. I called 211. Here's the kicker: 211 referred me to a nearby Baptist Church.
I go to the Baptist Church and it's the first time I've set foot in a church in YEARS. Incredibly, the Church says they have a good relationship with the pharmacy, and agree to pay the $95 for my prescription. I get the medicine, case closed. So -- thank you, Baptist Church in Texas.
I really am grateful to the church, but as a staunch atheist I am also really disgusted it had to come to this. Even though I am technically listed among the nation's lucky-ducky insured folks, that doesn't necessarily mean I am "insured" in any meaningful sense. Being insured does not mean you are insured, necessarily. Just like being employed does not mean all's fine and dandy economically, either.
-B.
Yoshie Furuhashi wrote:
"Even hospitals are beginning to think that offering free preventive care to the uninsured is better for their bottom line than to get saddled with the uninsured's frequent emergency visits and huge unpaid bills. The need for universal health care has to be the top domestic issue for American leftists to unite around, setting aside all other disagreements on domestic policy."