The title of this post is a bit tongue-and-cheek. I want to start right off the bat by saying that we are fortunate to have pretty good health insurance (a PPO) and a healthy HSA to help pay our out-of-pocket medical costs. That has not always been the case.
Background as a Broke College Student
I remember only having catastrophic coverage as a graduate student (no prescription coverage). There was one time I got sick and when I went to pick up the prescription my doctor had prescribed, it cost more than I can afford. At this point, I can’t recall details (e.g., don’t know the illness or prescription). What I’ll never forget, though, was standing in the lobby of Walgreens near-tears because I couldn’t afford the medicine to help me get better. I asked the pharmacist if I could fulfill a partial-prescription (the answer was “no.”). My pride wouldn’t let me call my mom to ask for help (which she certainly would have given). Instead, I left empty-handed.
Changes in Coverage
I’ve come a long way from that broke college kid. But how far, really? When I called recently to schedule an annual well-woman check with my OBGYN, I was informed that my OBGYN is no longer covered by my insurance. I would either have to 1) pay out of pocket for the cost of being seen AND the cost of the routine pap-smear test, lab results, etc. or 2) find a new OBGYN. What did I do? Option 3 – I have not scheduled an appointment. I know even typing this how reckless that is. But I LOVE my OBGYN. I don’t want another! But I also don’t want to pay out-of-pocket. So I’m stuck in limbo-land. Find a new provider? Or maybe wait until open enrollment and find a new insurance (but then what if my other doctors are no longer covered?). I’m so annoyed with the insurance company – and yes, I’ve written to let them know about my disappointment.
It takes me back, again, to my broke grad student insurance days. Maybe I’m scarred from those experiences.
I had my twins when I was a graduate student on that crappy grad student insurance. When I first sought care, I was planning to do the all-natural route and, therefore, I was seeing a midwife group. I was 20-weeks pregnant when I discovered – WOW! – I was actually pregnant with twins. I was thrust into the “high risk pregnancy” category and no longer qualified for the midwife group. I started seeing a doctor who had been recommended by my midwife. The problem is I HATED the doctor. So much. He made me cry almost every appointment. He was so harsh and impersonal and harped on all the risks and I was a first-time pregnant woman, living far from family and scared senseless. Why didn’t I switch providers? With my crappy insurance, I was only allowed to change providers once during the pregnancy. I had officially changed from the midwife group to the “mean” OBGYN and so I was stuck. I was not allowed to change again. The entire pregnancy from that point was really tough. And the birth experience was traumatic. I won’t go into details, but I fully hold resentment to the insurance company for “trapping” me in that situation.
I had a similar “trapped” experience recently. Or, rather, my husband did. Last weekend, my husband ended up in the ER for abdominal pain – we were worried it was gallstones, as he’s had an attack before. He was treated and released with a pain prescription and instructions to follow-up with his PCP. Unfortunately, a lot of our pharmacies have reduced hours over the past year or so. At this point, the nearest 24-hour pharmacy, a CVS, is a good 30+ minutes away (compared to our preferred pharmacy, Walgreens, which is maybe a 5 minute drive away). My husband was released in the middle of the night, so the ER doctor called his ‘script into the nearest 24-hour pharmacy, rather than our preferred pharmacy. We didn’t go to pick it up that night, as my husband just wanted to go home and sleep.
The next morning, I called to confirm that the prescription was ready for pick-up. To my surprise, I was told that the CVS pharmacy does not take our insurance and, therefore, had not filled the prescription. They recommended calling the hospital and having the prescription sent to our nearby Walgreens. I called the hospital, but because one of the prescriptions was for a narcotic, they could not transfer it to a different pharmacy and the prescribing doctor was no longer on-duty. I called CVS back again. “Looks like we’re going to have to pay out of pocket for the prescription, but can y’all transfer it to a CVS closer to our house so we don’t have to drive clear across town to pick it up?” Nope. Because one of the prescriptions is a narcotic, there are no transfers, even within another CVS store. We were stuck. At an out-of-network pharmacy, way across town.
So guess what. We drove all the way across town and paid out of pocket for the prescription.
What’s the point?
Here’s where I get into a bit of hyperbole because of course health insurance is important and had we paid out-of-pocket for all my husband’s scans and tests in the hospital, it would have been thousands (or tens of thousands????) of dollars. So I’m grateful for the coverage.
But if you’ll indulge my petulance for a minute…what the heck is the point in paying for insurance when they won’t cover our doctor of choice, our pharmacy of choice, our prescription medication, etc?
I know with 100% certainty I’ve used CVS in the past. When was it dropped from our insurance coverage? And in the case of my OBGYN, why would the insurance company not tell customers that they’re dropping the provider during open enrollment period when I’d actually have the opportunity to change my health plan?
It’s incredibly frustrating to pay big bucks to a health insurance company that feels like it’s just taking our money and cutting corners, refusing to cover care and prescriptions left and right! And so I return to the title of this post…..insurance is a scam! I said it.
I have been a loyal Blue Cross Blue Shield customer since I got my first full-time job in 2015. But this prescription fiasco on top of the OBGYN problem is the straw that broke the camel’s back. When open enrollment comes around, I’m officially going to look into other providers.
Anyone have a company you love that you’d recommend?
It’s such a bummer because I have a number of specialists (urologist, nephrologist), so if I make a change to my health insurance, I have to make sure my preferred doctors are still covered. I don’t need a referral with my current health insurance, and I want to make sure it stays that way. Do all U.S. companies just kind of suck now? Is that just what it is? Do I have to find a new OBGYN after finally finding someone I love? *cue whiny face* I hate to think others have dealt with these same struggles, but something tells me this is not an unusual situation in the current American health insurance climate.
Hi, I’m Ashley! Arizonan on paper, Texan at heart. Lover of running, blogging, and all things cheeeeese. Late 30’s, married mother of two, working as a professor at a major university in the southwest. Trying to finally (finally!) pay off that ridiculous 6-digit student loan debt!
Insurance is indeed a scam – you pay for it, but a lot of times it still bites you in the bum. I have no private insurance, none is provided by my employer and I haven’t ever paid into a separate plan for myself. I am luck that I am healthy but the day that changes, I hope I have coverage. I am Canadian so I have a lot covered, but not everything.
I found out the hard way this year. Apparently you can buy prescriptions with insurance, at a higher rate. Then it counts towards your deductible. Or you can buy it cash or with one of several free pharmacy discount cards at a much lower price. The pharmacy going to charge me 100+ for my medicine with insurance. I went online and signed up for a discount card and it dropped to 15$. It’s so dumb how healthcare is purposefully confusing and you have to figure it out by being ripped off first.
So dumb! Why does it need to be so confusing and challenging? The pharmacy told us for our out-of-pocket prescription that we could download some savings app, but it was a whole ordeal to get it all set up and create an account, etc. They definitely don’t make it easy!
Wow your insurance is crazy! I think I have most major pharmacies covered under my plan, it’s horrifying they can suddenly just stop covering it.
Insurance is always a fight to deal with, I know I’ve paid around 2k for about 5 hours in the ER (nothing special done either, just a visit with a doctor and an IV), healthcare costs are truly ridiculous, there’s no good reason to pay 2k for seeing one doctor and having 1 bag worth of IV! And this was all with insurance! I cant even imagine if I didn’t have it!
Yes!!! I’ve seen new mom’s detail their receipts from childbirth and its total nonsense. Like, a $300 charge for skin-to-skin contact (literally just placing the baby on the mom’s chest after birth). $100 for the plastic cup for ice/water, etc. Nonsense!
Keep in mind, it is not your insurance company that is dropping these doctors or pharmacies. It is the pharmacies and doctors who are choosing not to be a part of that insurance company. Generally it is because they cannot come to an agreement on what is considered a fair “usual and customary rate” to pay the doctor for services or the pharmacy for the prescriptions. In the past, I have made the complaint directly to my dr. and told them I would have to change physicians as I could not pay the out of network. I have had mixed results, one did nothing, the other offered me a discount on what I owed the office, ie BCBS would process the bill I would owe 40% to the dr. office, but the dr. office would then discount that amount so I ended up paying only 20%. Keep in mind, all the other providers that BCBS has in their network agreed to the rates, it is your physician who did not so for long term patients some will offer a deeper discount after the bill is processed. No, I do not work for BCBS nor any insurance company, but I do have family that have in the past and once they explained what really happens when a dr. is no longer in network and why it made me less upset with the insurance company. AND keep in mind this is how ALL insurance companies work so it will likely happen wherever you go; GENERALLY speaking the larger the company the less it happens, but it still happens. Good Luck.
This is really an interesting post and I appreciate you laying out all the nuance. I spoke to my OBGYN about it when I’d called to schedule an appointment, and they made it seem like they’d been trying to make a deal with BCBS for several months and were unable to come to terms. They claimed that BCBS gave a verbal confirmation, but then backed out when it was time to ink the deal. As with anything, there’s probably 3 sides (the doctors office, the insurance company, and the truth somewhere in the middle). Regardless, its super frustrating and inconvenient as the patient.
We are self employed. Gave up traditional insurance at the end of 2017. My husband had a procedure done which would have satisfied his deductible but the insurance company coded it as “co-insurance” instead. This was after having to appeal to the state insurance commission to get them to cover another procedure.
We now participate in Christian Healthcare Ministries. He had another procedure done, I’ve had mammograms, colonoscopies, knee surgery and everything has been covered. We don’t have to worry about networks, etc. We self insure one off office visits, physicals and daily meds and they cover “incidents”. It’s worked really well for us.