A FREE MARKET ODYSSEY

Posted in Rants on January 11th, 2011 by Ed

What follows is a story that is true in every detail, a tale that is, to borrow a phrase from ex-President Bush, "uniquely American." Rather than giving away the ending, I will tell the story chronologically (and for the sake of the reader, as succinctly as possible).

Nov. 30, 2010: Recognizing that I would run out of a prescription medication sometime in early January, I called my doctor to make an appointment. As is the case with most "managed care" insurance plans such as the one offered to employees of my current university, patients are funneled through a ludicrously small number of "primary care providers" who serve as gatekeepers to specialist physicians, lab tests, outpatient care, and prescriptions through the insurer. Since it takes an average of around 6 weeks (yep) to see this overwhelmed small medical practice, calling shortly after Thanksgiving afforded me a slim chance of seeing the doctor before my pill bottle ran dry. I was lucky enough to secure an appointment, though.

Dec. 31, 2010: My Blue Cross health insurance expired effective this date because…

Jan. 1, 2011: Having had the temerity to get married in 2010, I started a new insurance plan with the new calendar year under which my spouse is also covered. The new insurer (I will point no fingers, but it rhymes with "Miser Hermanente") sent me not one piece of information in the four months (August 7 wedding) preceding this transition. Not an email, not a new insurance card, not a form letter. Nothing. I had to re-check with HR several times to ensure that I had filled out the requisite paperwork correctly. I was assured that new coverage would begin on 1/1/11.

Friday, Jan. 7, 2011: I saw my doctor for about 30 seconds. He wrote me another 12 months' worth of prescriptions and refills. See you in 2012, health care provider! I'm glad we had this talk.

Saturday, Jan. 8: Having missed the closing time of the Kroger pharmacy on Friday evening, I went to pick up my medication on Saturday morning. They informed me that my old insurance number was invalid. Never having received a new one, I called Miser Hermanente. They have no customer service reps of any kind available on weekends. None. I resolved to call them first thing on Monday and return to Kroger.

Sunday, Jan. 9: My prescription ran out. Abruptly quitting anti-seizure medications can cause…seizures. I am worried.

Monday, Jan. 10, 10 AM: I call Miser Hermanente and discover that due to inclement weather, all Georgia offices are closed and only a skeleton crew is available. The weather is no one's fault. I wait on the phone for an hour before a nice, harried lady tells me they have no record of my existence. I have no account number because "They're a little backed up entering new customers for 2011." 30 minutes pass before she manages to push whatever magic buttons are necessary to enroll me in their system and give me my very own ID number for the insurance plan.

12:00: Armed with this information I return to Kroger. They cannot bill my insurer because Kroger pharmacies are not in the Miser "network." Nor is CVS. Nor Walgreen's. Nor Wal-Mart. Nor…anything except Rite-Aid, which I thought had gone out of business in the mid-80s. The nice pharmacist calls all three Rite-Aids in town to transfer the prescription. None are open due to the winter storm (or what passes for one in Georgia).

1:00-3:00: I work the phone attempting to find an open Rite Aid and arrange the necessary bureaucratic mating rituals. Shortly before the Kroger closes at 3, I find that one pharmacist has arrived late in the afternoon at an open Rite Aid 25 miles away. I catch the Kroger pharmacist as she is walking out the door. She angrily agrees to call the Rite Aid for me.

4:29: I arrive at the Rite Aid. Due to the lack of snow/ice removal equipment in the south and the complete inability of anyone in Georgia to drive a car in winter conditions, the 25 mile trip takes almost 75 minutes (I left around 3:15).

4:30: Armed with my Member ID number, I stride with pride into the empty Rite Aid. The kind pharmacist readies my medication, and none too soon. I am feeling shaky (literally and figuratively) at this point.

4:35: Apparently, says the pharmacist, Miser uses some subcontractor to manage its prescription billing and they have no record of my existence. My ID number and other information from Miser is useless. I call the company again. Fortunately, wait times are reduced as more employees staggered into work throughout the afternoon.

4:55: With the Rite Aid about to close (and freezing sleet starting to come down atop the snow) the Miser representative gives me a final "I give up. Call back tomorrow or something." I take out my American Express and pay $633.35 for 30 pills – about 55 hours after I went to pick up the prescription the first time.

April, 2011: Ed receives reimbursement from his insurer, although it is much less than the amount he paid because their rules state that prescriptions should be billed directly rather than paid and submitted for reimbursement.

THE MORAL: Aren't you glad we don't have government-run health care? Just imagine the high cost, poor customer service, long wait times to see a physician, and nightmare of bureaucratic hoop-jumping we would have to deal with. Why, we would have to navigate a labyrinthine bureaucracy for days on end just to refill a lousy prescription.