I'm facing a moment of moral crisis. The medicine my doctor prescribed for my asthma cost $75 a pop and frankly, I can't afford to pay for it. I mean, I could, but it'd create a huge hole in my pocketbook and I'd hafta cut back on other frivolous purchases (like food, rent, and hookers). It's a lot of money to pay for medicine--I mean, that's what I have insurance for, right?
See the reason it's so expensive is because there's no generic equivalent available. Generics medicines cost me like three bucks to buy. But since a generic isn't available, I gotta pay full cost of the drug, putting me in a tough spot. I spoke with my doctor regarding the situation and he said that he'd prefer if I was the drug, but offered me an alternative to take.
"It's not as strong and you would have to take it four times as much," he said.
As if that wasn't bad enough, there's no generic available for that drug either. So not only is it not as strong or effective, it'd end up costing me four times the medicine I'm on now.
Clearly this is not the solution to my problem.
I filled an appeal with my insurance company that they promptly denied. I received a letter saying; "based on the above terms (of your plan), I regret that we are unable to comply with your request." I found this extremely annoying. I already knew that I had to pay full price for the drug "based" on the terms of my plan--that's why I filed a grievance. I'm not a freeloader--I have no choice in this matter because there is no generic option available. But it feels like my claim wasn't even considered or reviewed because the terms of my insurance. That's not much of an appeal.
There is a clause in my insurance that states once I purchase $150 worth of a brand name drug in a calendar year, I can get all subsequent purchases for $25. While it's disappointing, at least I don't hafta pay the $75 every time I need it.
Only one little caveat...the first time I purchased my medicine was the last week in December. I didn't know about the clause; I didn't know about the appeal process. All I knew was I desperately needed to breathe and had no other options. Unfortunately, even though that $75 was spent during the weaning days of December, it does not carry over to the next year. Basically, my balance is at zero and I gotta spend $150 before I start receiving any sorta discount on the drug...all because my doctor's diagnosis didn't arrive a few weeks later.
And that's what pisses me off. I suppose, maybe, if I had to, I'd pay another $75 and then start getting the drug at a discounted rate--but I can't spend $150 more. It doesn't seem fair or just--especially because that's what I have insurance for in the first place. I mean, what exactly am I paying them for? I gotta pay $20 to the doctor every time I see him...when I never received $20 worth of service, attention, or medical diagnosis. Now I need drugs to help me breathe and the ruddy insurance won't pay for it? Why exactly am I keeping these folks around?
The insurance and pharmaceutical industries are two of the more profitable businesses in America (I don't recall where I read it, but I know it's true). One of the reasons they're making cash hand of fist is stuff like this. At the very least, they should be able to give me credit for the $75 I spent in December. Oh crap--I just realized something: I spent $74.95. Not 75! So if I spend another $74.95, I still wouldn't reach the 150 mark--I'd hafta spend ANOTHER 74.95! That means I woulda purchased the drug four times for a grand total of $299.80.
Like hell--I'm not throwing 300 bucks away on a drug that's not gonna get me high or laid. As Willie Mayes Hayes said; "It ain't that important." That stupid, lousy nickel is gonna cost me a fortune.
I started this iRANT wondering if I should continue pursuing this; that was I really that important enough for exceptions to be made? I like to believe I'm no more important than anyone else ('cept for Raider fans). The appeal process was designed to help dying seniors on welfare--not good-looking, twentysomethings like me. I was wondering if it was moral to appeal the decision just because things didn't go my way and I was inconvenienced. I would be wasting numerous man-hours (and money) with all the phone calls and letters I plan to make. It didn't feel right--it felt selfish.
But now I realize it's all a load of crap. I am being wronged--what's happening is unjust. The money spent at the end of December won't carry over because of policy. I won't receive any help with the insurance company because of policy. No insurance company ever wants to honour your claim (because of policy) and they look for any excuse not to do so. I don't like policy--life isn't black or white. I've had garbage like this happen to me by my auto insurance company, too. The reason that they get away with it is because no one fights back.
Moral dilemma solved.
Onward march!
