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Reason #417 Why Insurance Companies Suck

Jan 8 2005

So this last week has been the first time in about two years that I've been laid-low, really harsh down-sick. Coincidentally, this is also approximately the period of time for which I've been covered by decent health insurance. This is one of the good things about health insurance: fate isn't anywhere near so tempted by the insured as the uninsured. Actually, I don't know that for a statistical fact, so if any actuaries out there want to weigh in, that'd be nice.

And actually, I don't just have one insurer. I have two. Last September when the company I work for was pushing to get our group health coverage knocked up to the next level, I found myself with an offer from them which would cover me at about $45 a month. I didn't think for a second of dropping my independently purchased major medical coverage -- I've learned that if you really want continuous coverage, you have to make sure you do it independently -- but I did note the work-offered plan would re-introduce me to the world where doctor visits and drugs were covered. Yay, Blue Cross! This seemed good.

At least, until I tried to use it today.

I'd just given my prescriptions to the pharmacist, and was wandering around ShopKo looking at clothes and studying the construction of their bunkbeds when someone came over the P/A and asked me to return to the pharmacy. Figuring they had filled my prescription, I marched to the "Pick Up" window... and the pharmacist stood firmly by the other window, where you drop off prescriptions and apparently discuss "issues." She explained: they'd run my insurance and gotten back an automated message from our friends at Blue Cross which said "your other insurance company is the primary provider -- you have to try to get them to pay for your prescriptions first."

Note that just two days ago I called up Blue Cross customer service to go over this with them, just in case there was any question. I explained that my other insurance is basically a major medical/catastrophic plan, and that I wanted Blue Cross to be the primary insurer -- was this fine? The woman I spoke with on the phone seemed to have no problems with this, and I hung up the phone with visions of antibiotics dancing in my head.

But there I was tonight, the pharmacist telling me that Blue Cross's was not going to dance with these antibiotics. I looked her in the eye and said "they are primary insurer" and she looked weary and said that Blue Cross's customer service desk was closed and there wasn't anything she could do. And I was thinking to myself about what I would say to her if she were in fact a Blue Cross rep: Look. I pay you a premium to be covered underneath a certain plan, and when that plan covers a given service or product, I don't want you to go looking for somebody else who might pay for it instead of you, just because they might be out there. I mean, yes, it does make a certain amount of business sense to see if you can try and get the other insurance company to pay for it, but you know, what would be next? You wanna call up my Mom & Dad? Because they're good like that, they'd probably help out, and that way, you wouldn't have to waste any of that precious premium which I may have mentioned you've been paid. And I have some friends who I might even be able to go to in a real pinch, you wanna call them too? Or maybe we could start a fund-drive or something, put my smilin' face on a jar at the supermarket check-out and the bank, saying "Needs antibiotics to live," and after a couple of weeks of compassion by the quarter from random shoppers, you could recover the cost of the Zithromax. Or maybe you wouldn't get it all back, but at least you would have exhausted all the options -- you could sleep knowing there wasn't anybody else you might just take care of it for you.

In tonight's case, that someone was me. I wanted to start the antibiotic course enough that I just paid the $50 for my 7 pills. No problem, I'm there for you, Blue Cross -- just in case you need someone to stand between you and fulfilling your policies.


This article is typical of how Ins. Companies try to get you. Here is another way, they make their website and their explanation of benifits so unintelligible that you need a lawyer or a PHD in BS to tell you what your benefits are. Yeah, it is to the point where you just say "I will pay for it" or you just do not go to the doctor, because your not sure if your insurance is accepted (or worth a dam).
2005-03-17 13:30:36

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