In mid-August, we suddenly (? at least it was sudden to me — it’s possible Bob had known for a while and forgot to tell me) found out that our insurance company would be changing on Sept 1. Not unexpectedly, the new insurance plan is much crappier for the same money.
The way we pay for health care in this country is seriously broken. Tying insurance to an employer is a ridiculous system which traps people in dead-end jobs and chains them to for-profit “insurance” companies that manage health resources in completely unethical ways. Capping payments on a yearly or lifetime basis for medicines or treatments that a licensed physician has deemed medically necessary is abhorrent and should be criminal. No one should go broke because they get sick, but also, no one should go broke because they or their child has the misfortune of having a chronic, long-term problem that requires continued outlay of money over time.
So this has been a source of extreme stress to both of us and continues to be so, because apparently no one is able to answer even the most basic of questions. We have asked the new company multiple times what happens in 6 months after Dorrie blows through her $25,000 lifetime limit on “durable medical equipment”, a term which includes not just the rental of her ventilator, sat monitor, suction machine, and feeding pump (all of which are durable and should last for years), but also all of the disposable supplies that go with them. No one at MVP will give us a straight answer. Finally, after waiting for weeks, we got our benefits book in the mail, but I cannot make heads or tail of the doublespeak that passes for an explanation of what they will or will not pay for.
I am not encouraged after the horrific time we had just this past week trying to get one of her prescriptions re-authorized. We called in a refill and were told that the new insurance required prior authorization. The doctor tried to fax the insurance the info, they claimed they didn’t get it. Meanwhile, we are nearly out of our current supply. We finally get all this cleared up (after 7 days of daily calls to the pharmacy and the doctor’s office) only to find out that medicaid (the secondary insurance) now needs a re-authorization too. *insert swearing here*.
The doctor’s office seemed to think this was an error in billing on the pharmacy’s part — so we shall see.
It’s ridiculous that there are actual vocational programs to learn how to do medical billing. It should not be this complicated.