There is a family that this writer is very close to. I have known them before they first married, watched them go though the good and the bad. I have, witnessed them bring two beautiful daughters and a son into the world. We are talking Wheaties box stuff here. The American dream, conservative in politics and life in general. Not the Cleavers, but a rock solid example of American values.
We all know that with the good, well, there's always some "issues" that come with this deal of "living life on life's terms." In this family's case it has been health issues.
Mom suffers from fibromyalgia which results in constant muscle and bone pain, throw in a good dose of an anxiety disorder and problems with sleep. Her laundry list of prescription drugs are: Soma, (muscle relaxant), Vicodin, (used only when in extreme pain}, Klonopin, (anxiety) and Trazodone (sleeping).
The oldest daughter, thirteen years old, was blessed at birth with ADHD, Anxiety attacks, and Bi-Polar Disorder. She must ingest daily doses of three different drugs, Strattera, Abilify, and Zoloft.
Dad has high cholesterol and is stuck with the drug Lipitor for life. But here's the kicker, Dad also very recently took a new job, more money, more perks, "moving on up,"...as the Jefferson's would say... Sounds great right! Well, everything was just peachy until he recently discovered his new prescription co-pays basically jumped from $10 a shot per prescription to a whopping $50 per script. Blue Cross, not exactly a shinning star in the medical field, was charging about $80 a month for all their meds. The new company, United Health, will charge them about $400 a month for the same medications. In addition, the family pays an additional $361.00 per month for their basic health plan. This of course, is just the employee's contribution, the employer will pay way more on it's end.
It is easy to fault the couple for some of this new dilemma. Shouldn't they have done the some research on the "new" insurance prior to making this new found "commitment"? In hindsight, of course they should have. Didn't happen, facts are, the barn door is open and the horse is out in the pasture, and mom and dad are trying to make some sense out of the new predicament that they have found thier family in.
A call was made to the new protectors of all things "health" for this typical American family of five.
The response given is so stunning, I am both shocked and amazed that the "representative" of United Health would actually utter the words he did, as he explained his company's policy on "prescription co-pays."
When asked why the "co-pays" were so high, it was explained that this company operated on a "THREE TIER" basis. Certain drugs were listed with a $10 co-pay, others were listed with a $25 co-pay. The third tier was the $50 buck co-pay, and unfortunately, every single one of this family's prescriptions were categorized in the third tier.
All?, asked the mother. All, responded the spokesman. Then the unbelievable was uttered. This representative of the insurance company suggested some "replacements" for the prescribed drugs that would fall under the lower tiers. Mom, quickly responded, "but that was not what was prescribed by my daughter's doctor." The "representative", replied, "Well, I just wanted you to know what was available on a more economical tier."
The mother then asked the "Question of all Questions."... "And just who makes these decisions on what medicines are allocated to each specific tier?"......Either the "representative" had recently been given a injection of some sort of truth serum or he felt no shame in responding: "Oh, every once in a while, members of the pharmaceutical companies meet with members of the insurance company and those decisions are made." Don't you find that amazing, your trusted insurance company has no problem suggesting a cheaper medicine might be just as good as what your doctor, who after a detailed diagnoses, prescribed? Especially a prescription that deals with something so volatile as ADHD and Bi-Polar Syndrome. That is F***ing scary.
Ah, but I am not done yet. As an experiment, I suggested that the young lady, take a couple of prescriptions, along with her AAA card, (Yes, the Automobile Club will get you a substantial discount on prescriptions), and go to Von's and tell them you have NO, as in None, insurance and see what the charges would be. To everyone's amazement, the prescription for Vicodin was $14.00, and the prescription for Soma was $32.00. That results in a savings of $54.00 by NOT using her insurance. That is nuts!
However, if you a one of the many uninsured Californians that suffer from a bi-polar disorder and your doctor prescribes the medication Abilify, it will only cost you about $600 for 30 days of sanity.
Does any of this make any sense to anyone? If so, please, let me in on the secret. Tossing all fears of a socialized America aside, I shall vote for a presidential candidate that will give us "Universal Healthcare."...It should be America's number one priority.
"The United States is the only wealthy, industrialized nation that does not provide universal health care." (Wikipedia)
WORLD - AN EDGE IN MY VOICE
Copyright © 2010 Steven Lane
Who's in Charge of Your Health? It Might not Be Your Doctor
Who is prescribing your medications? Is it your doctor, or is it a panel comprised of pharmaceutical companies in concert with your insurance company?
Copyright © 2010 Steven Lane
About the WriterWant to write articles too? Sign up & become a writer!
9 comments on Who's in Charge of Your Health? It Might not Be Your Doctor
Rate This Article
Your vote matters to us