Over the course of the last several years, I have had a rather sudden exposure to our Country's healthcare industry. I have met some great healthcare workers from nurses to doctors to technicians and everyone in between. I probably wouldn't be here without those people. After three strokes, a heart attack and a cancer scare , I feel very fortunate every morning I wake up and put my feet on the floor. The people I have met and the services I have received along the way for the most part have been exceptional, and I might even say amazing when you see life saving technology in action,
but dealing with insurance issues have sometimes been a nightmare.
The latest happened yesterday.
I have been under the care of an outstanding Opthamologist who in my opinion has been working miracles to save and restore my eyesight. Yesterday I had an appointment with him and he noticed my eyes were irritated and I told him I thought it was just allergies from all the spring pollen.
I guess it has been a tough spring for many with allergies and he offered to prescribe allergy drops for my eyes.
OK, so far so good. Relief , I thought, was in sight, No pun intended.
Before I reached the parking lot from the Doctors Office, I was already getting an automated text messge from the Doctor's Office, confirming that a prescription had been sent in to the Pharmacy I use and it included a link to a phone app, GOOD RX, to check pricing and other information on the prescribed drug.
Good Rx is a great app and I look at it often to look up prescriptions as well as instructions and side effects. It is a great resource and the "GOOD RX" app is free.
So anyways, I was a little surprised when the Pharmacist called and said Insurance needed a "Prior Authorization" from the Doctor before they could fill the prescription.
I had already looked up pricing on GoodRx. so I said to the Pharmacist that I was a little surprised that they would require a "Prior Authorization " for a $63.00 prescription.
I was floored with her response. She said $63.00 was the price if I paid "out of pocket" , since it was going through Insurance, the price was actually $210.59. An almost 300% markup on eyedrops. ( And loansharking is illegal, this should be also) This should be criminal to gouge the Public like this and if it was any other business the Justice Department would be investigating and indictments would be forthcoming.
And this is just one of many examples I could give. I had one prescription that I had been paying out of pocket before my stroke, my cost was $28.00 and I gladly paid it After my stroke, my Insurance company refused to pay for the $28.00 drug because "It wasn't part of their protocols", whatever that means, I guess that might be Insurance speak for "we don't get kick backs from that company". But instead they were willing to pay for a comparable substitute at almost $1,000.00 a month. $28.00 or $1000.00. big Insurance opts for the $1000.00 alternative
And we wonder why the system is broke
Our Insurance system is broken and needs to be fixed