Health Insurance, Prescriptions, and Annoyance

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So, let me throw out this disclaimer before I get started: I have not called or contacted my health insurance company, or anyone else’s for that matter.  Anything involving health insurance is obviously a controversial subject, and I am NOT the most informed person in the U.S., possibly not even the most informed person in my state of residence, county, or city.  Also, I will not be going into detail about reproductive organs or anything elicit, but this isn’t something I would want a nine-year-old to read, either.

Growing up, my mother was a stay-at-home mom.  My father was blue-collar worker and member of a union.  We had health insurance, and money was always tight and I think sometimes non-existent, but we always had everything we needed.  If we needed to go to the doctor, we went to the doctor.  If we needed to go to the dentist, we went to the dentist.  There was never a question of whether we could afford to go or not.  I can’t say for sure, because I was a child, but I don’t remember my mother ever paying more than a few dollars for a copay or having to wait until payday to pick up a prescription.  

Now, before you close your browser window or app, or move on to something else, let me just say this… This is not going to be about the Affordable Healthcare Act, or as most Americans know it, Obamacare.  This is completely, 100%, about my health insurance company and its overwhelmingly illogical logic.  And the changes that have occurred in my lifetime.  And probably some rabbit trails thrown in because I can never seem to resist straying from the main topic.

As anyone who follows my blog knows, my husband and I have had some infertility issues.  Something called secondary infertility, to be exact.  And my body, because it secretly hates me, needs replacement hormones to do just about anything these days.  It’s been too busy making the wrong hormones for too long and it isn’t cooperating with my efforts to get the right hormones on the factory line, or rather, emanating from my ovaries.  I am one of those PCOS girls, as my OBGYN likes to call us.  Somehow she makes it sound like we are in an elite club, or like Girl Scouts, or something that doesn’t mean reproductive issues and extra facial hair.  That reminds me, where did I put that Nair?  Oh well, moving on.

Very, very briefly, PCOS stands for polycystic ovary syndrome.  This typically means your ovaries are making eggs but not maturing these eggs and not releasing them and then they turn into cysts.  There’s much more to the disorder (like wacky hormone levels and insulin resistance) than that but that’s not what this is about.  If anyone wants more information, I will gladly point them in the right direction, just contact me.  

If we weren’t trying to have a child, the treatment for PCOS is diet, exercise and birth control pills to help with the wacky hormone levels.  Since we are trying to have a child, the treatment is diet and exercise and some extra hormones to try to get the body to cycle naturally.  

Think of it like jump-starting a car.  Sometimes a light gets left on in the car all night or all day, and you go out to start it and nothing happens.  So, hopefully, you get some jumper cables out and hook it to another battery and after a few minutes your car starts right up.  Next time you go to start the car, it starts on its own again, and again, etc.  I won’t go into disgusting detail, but these hormones are like jumper cables.  Some PCOS girls have just left the light on overnight, and others need brand new batteries.  So far, it seems that I just left the light on too long.  

In an effort to naturally recharge the battery, I have lost thirty pounds and eight inches through a lot of sweat and tears.  I have completely changed my diet.  I don’t even eat solid food two meals out of three, I juice (no, this doesn’t mean steroids, and no, I won’t be explaining right now for the sake of brevity).  I exercise five to six days out of every seven, for an hour minimum.  I have made every effort I can possibly make to get my body to function the way it was intended to function.  But its not working!  

Enter stage right: clomid.

Clomid is a medication that is supposed to, hopefully, result in stimulating ovulation (making my damned, over-possessive ovaries finally let go of a mature egg!).  I have to take it for a few days on a very specific schedule, wait a specified amount of time, attempt to reproduce (wink, wink), get my blood drawn, blah blah blah.  You get the picture.  It isn’t fool-proof, it isn’t ideal, but it is the best chance I have at achieving my hopes and dreams.  Yes, I realize just how corny that sounds.  No, I do not care.  

It isn’t that expensive in the realm of things expensive.  It’s something we can easily pay for without it being detrimental to our lives.  We won’t have to push the pause button on our efforts to have a child, or jump the car battery or whatever (I’m getting lost in my own metaphor, enough I say!) and save up money to pay for the five days of medication needed.  I can just purchase it and move on with life.  When I went to pick it up, the insurance gave resounding statement of  NOT COVERED, but it is affordable.  So, not that big of a deal.  It isn’t like I’m one of those women whose hopes and dreams hang on the promise of IVF (in-vitro fertilization) which costs $10,000 minimum each try and isn’t covered by any insurance company in the U.S. to my knowledge.  So in the grand scheme of things, this is a minor complaint.  Just a little blip on the giant map of complaints.

So what’s my problem?  My insurance company will not pay for birth control pills, either.  Not that I want them, it is a principle kind of thing.

When the pharmacist had informed me that the clomid I was trying to pick up wasn’t covered by my insurance, I was taken aback for a moment.  I stuttered for a moment before I finally asked how much the prescription was going to cost me.  This is when she inserted that I should be aware they also won’t cover my birth control pills if I were ever to decide to go back on them (not that there is any point, I can’t conceive a child, obviously).  I stuttered a bit more and she supplied the price in my moment of intelligent sounds (like “der, der, der, uh, uh, um…”).  I sighed in relief after she told me the price of my prescription and I realized it was most definitely affordable.

So, again, what is my problem?  Well, it makes me angry.  I know this is a first-world problem, but seriously?  

Let me get this straight, health insurance company, you won’t pay for the pills needed for me to NOT get pregnant, and you won’t pay for the pills needed for me to GET pregnant.  So you don’t want to pay for a pregnancy, I can see that as logical, but you also don’t want to pay to prevent a pregnancy?  I’m scratching my head right now, in complete, undisguised confusion.  I don’t get the logic unless it’s simply a mentality of let’s not pay for as many things as possible. 

Now that should be the end of my rant.  Time to move on with life…right?  Of course not!  My brain does not work that way.  I do not just “let go” of things that defy logic.  I need an answer.  I need a rationale.  I begin to think about the problem in depth.  Not that I will come up with any epiphanies, but I still try.

It is moments like this that remind me that health insurance has changed.  The world is revolving around the bottom line and praying to whatever or whoever they believe in that the bottom line is written in black ink and not red.  Wait, I’m not even sure that is the prayer anymore, to stay in the black.  The prayer seems to resemble that the numbers in black are huge, multi-comma requiring amounts.  It isn’t about a logical course of care, or even ensuring people are provided with the best standard of care.  It’s all about the money.  Boy, has THAT phrase been overused.  But it is so accurate, why wouldn’t it be overused?  

Growing up we had a reasonable expectation of care.  My family and I have never been the type of people that expect to live 100 percent perfect, pain free, healthy at all times.  The body doesn’t work like that.  There are ebbs and flows with the body just like with everything else.  It’s not going to perform at a perfect ideal for every minute of your life, especially if it’s not operating under ideal conditions, like obesity, poor diet, lack of sleep, lack of exercise, you never see the light of day because you’re always stuck inside in front of a screen, in a cubicle, behind a desk, etc.  For the immune system to work right sometimes you have to get sick.  That’s just the way things work.  But within our reasonable expectations we also fully expected the insurance to cover a portion of our reasonable needs.  

Now we pay the insurance company boatloads of money, for what?  I pay them approximately $5,000 a year to cover two people.  What is it that they’re covering?  

Is it more about who are they covering?  Are they so busy taking my money to pay for Joe Schmoe down the street that thinks that he should be perfect at all times that they can’t bother to pay for birth control or clomid?  I know I have heard more than once that so-and-so is going to the doctor not because he/she is sick, but because they want to make sure they are getting what they pay for out of their insurance.  Is that part of the problem?  Has health insurance become based on logic of the cynical and jaded through misuse of consumers?  Why don’t they tell Joe Schmoe that sorry, we can’t cover this or that because you have unrealistic expectations and you are taking advantage of us?

The world has changed.  It is all of us, not just the health insurance companies, that are to blame.  Now please, don’t inundate my inbox with letters telling me how much of a moron I am for putting the blame on consumers instead of providers or health insurance companies.  That is not the point I’m trying to make.  We are all responsible in our own way for the health care system, its failings, and its triumphs.  Most of us walk around in our own world.  It is the way we are built.  We don’t usually pay attention to a problem until it becomes OUR problem.  Once something is affecting us, or our mom, or our crazy aunt, or grandpa, we get angry.  We get upset.  But then, what do we do about it?

What would you do about it?

I’m not saying I’m perfect, that I am an activist for all causes all over the world.  All I’m saying is this, when I do finally have a moment where one of those nation-wide problems suddenly becomes personal, I need to do something about it.  I need to tell the people that are in the position to affect change that there is a problem.

That person in the position to affect change is just like me.  He or she isn’t evil.  He or she is just human.  The problem X amount of people are facing won’t mean much in the abstract.  That’s if he or she is even aware of an abstract problem.  If there is a personal angle there for that person, they will work harder to fix the problem.  If I can’t accomplish anything else, maybe, just maybe I can put a story, face, voice, or personal angle on the problem that will help get the right person to take an interest.  Maybe.

Maybe is still better than nothing.

Maybe is all the hope I seem to have with a lot of things these days.  But I’ll take a maybe any day over a no, not happening.

At this point, my issue isn’t over just one prescription.  My issue is with a pervasive change in American culture that just doesn’t make sense to my brain.  We have these opposing ideas we are trying to juxtapose, but instead we are getting an all-out train wreck that isn’t even in the same category as two opposing ideas coming together to form a contrast.  We are teaching our children that everyone else is responsible for the greater good, but that the greater good should be for MY benefit or it isn’t good enough.

Although, it might be possible that I need some chocolate and a Midol, instead of a blog.

What do you think?

 

 

I would like to take a poll and ask everyone to please answer.  This poll expires in one week, so don’t wait to answer!

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2 Replies to “Health Insurance, Prescriptions, and Annoyance”

  1. I do believe that the Affordable Care Act is a step in the right direction, and that President Obama’s heart is in the right place, although we are still a long way from the single-payer system that we so desperately need in this country. Every other industrialized nation in the world has universal health coverage, associated closely with “socialized medicine,” a phrase that has become a dirty word in the U.S. for many reasons. From where we stand now, it’s all about profit. I am very liberal in most (but not all) things, and you can call me whatever name you want, but I believe that certain basic necessities such as food, shelter and medical care, should be guaranteed to everyone. FDR was right in his commitment to securing “freedom from want.” Unfortunately, the Tea Party conservatives, ultra-right-wing Republicans, the Hannitys and Limbaughs of this world, don’t agree. As you have found, American health insurance providers do not want to pay for ANYTHING related to pregnancy, including prevention thereof, because this would cut into their profits. In other words, if you want to become pregnant, that’s not an unavoidable illness — it’s entirely your decision and it’s on your dime. As to preventing pregnancy, abstinence cost nothing. Lovely, right? I say let’s all move to Canada.

    1. I agree that something needs to change, and that while well-intended, the Affordable Care Act didn’t get us where we need to be. The result for my family has been an increase in premiums, which is obviously not making health care more affordable for my little circle. But what exactly needs to happen is a debate that we have been having for decades and will continue to have for decades to come, I’m sure.

      As for paying for pregnancy-related services, I think something will have to give, and soon. Many states are pushing for a change in legislature that requires health insurance companies to pay for infertility treatments such as IVF. I know there is a large constituency in Utah pushing for a change right now. Hopefully other states will stand up and demand some changes as well.

      As for Canada, it gets awfully chilly up there. Here’s to praying it never comes to that!

      Mindy Minix

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