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Joys of Health Insurance

Up to now, I'd managed to escape any sort of daily prescription medication--I think my last prescription may have been filled 2 years ago. But today my internist decided to put me on a statin called Crestor, as my CRP (a marker for heart disease risk) is elevated and my LDL cholesterol is also high. So, he writes the prescription at my morning appointment, and I truck off to my office and get immersed in Stuff.

Toward the end of the afternoon, I start thinking about getting the prescription filled, and decide to see what the Aetna Web site says it will cost. I also decide to check out the other drug that he just gave me some samples of, Nexium. That one is a test to see if it affects the chest/throat pain that started all this round of doctors and tests (and to some extent, the incentive for the weight loss attempt).

The Aetna site's Price-A-Drug is not very informative: it won't give me a cost, because neither of these drugs are allowed under my health plan. Information of a different sort, I guess... The doctor can request a "prior authorization" (somehow I don't think this phrase means what they think it does...) for me to get it, but if he does, the months' supply will probably cost me $80 (still a lot better than retail, I'm sure). I call my doctor's office and relate this to them, give them the phone number of the pharmacy I plan to use, and go back to Stuff.

This evening I got to the pharmacy to see what had transpired, and ended up with a pharmacist who couldn't grasp the concept that she was speaking in an arcane pharmacy/health insurance jargon to me. She finally got across to me that the doctor had called in a prescription for Lipitor to replace the Crestor (OK, fine), and they had filled it, but that it was "paid for" with cash because my insurance was invalid. "Paid for" was finally translated to "how it was marked in our pharmacy computer in terms of insurance"--that took me a while to grasp. Then I had trouble explaining to her the unlikelihood that my employer, the U.S. government, had randomly switched insurance carriers at the first of the year. (For those who don't know, there's a set of insurance options under the Fed. Employees Health Benefits Plan, and each employee gets to choose the coverage and the associated cost that they prefer. Thus I was sure that my health insurer was still my insurer, thankyouverymuch. Along with the evidence that I was logged into my account on their Web site 4 hours before, checking my personalized information.)

After much more of this non-communication, she tried putting the (now unneeded) Crestor prescription into the computer to see what happened. My insurance number again was kicked out as invalid, and she agreed to call the company to ask. Somewhere during that conversation I realized that the pharmacy had both the insurance card number and my birthdate in as identifiers, and that they gotten this information off my card. Bing! I found out this fall that the insurance company had a totally wrong birthdate for me, and got it corrected--but the card still had the bad one. I whispered this to the pharmacist, she changed the date in her computer, and all was copacetic. Although the Lipitor did cost me $40 for a month's supply. Must ask doctor if other statins will do as well for me.

And, if the samples of Nexium do indeed help the mysterious chest pain, I'll have to go repeat this lovely experience shortly.

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nlbarber
Nancy Barber

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