Friday, January 14, 2011

Getting "Insurified:" The Shortest Distance to Procuring Medical Debt

Ah, the good old days…

I feel like it was just yesterday that I enjoyed free health care, including free Tysabri infusions, as an uninsured MS patient on Social Security disability but no Medicare.

Wait a minute—it was yesterday! Or practically so. After marrying Mark in December, I received one January morning a blue and white plastic Blue Cross insurance card bearing his name. I now have coverage under hubby’s insurance and it’s time to tell the world. Or at least the docs at my charity clinic and the people at Biogen idec who gave me a free ride on Tysabri. Everything must change, that much I know.

The Blue Cross people trotted out my benefit summary on the phone; mainly, my coverage amounts to an 80-20 split plus a $250 deductible. My face went white as I calculated twenty percent of the $16,000 a year cost of Tysabri. Surely, I thought, any service provider who has a contract with Blue Cross will accept the 80%, waive the deductible, and call it good. One customer service rep told me they would, but a second one told me I might be responsible for the deductible and co-pay. I tried to pin them down on whether or not I’d be billed, but nobody seemed to know for sure.

Next I asked Blue Cross for a list of in-network infusion clinics I might use. They were stymied by this request, but fifteen minutes later I was given a list of places to call. They turned out to be specialty pharmacies, not infusion clinics.

Welcome back to the wonderful world of health insurance.

Next I called the charity clinic and asked the receptionist if I should find another neurologist now that I have insurance. “Yes, please do,” she lectured, “that way you will make room for people who have no insurance.” I thanked her and hung up, hoping that I hadn’t taken up too much of her valuable time administering to the poor and suffering, now that I was no longer considered part of the flock. After a few hours, it struck me that I really should have talked to my doctor. You don’t just walk away from a specialist you’ve been seeing for a serious disease who probably would like to coordinate the changeover in your therapy.

A reminder that I must always be my own advocate and demand the proper care.

The Tysabri people put me on a different assistance program, one for the insured among us who are getting fleeced by high co-pays and deductibles. My cost is $10 a month, which is affordable, the best news I’ve had thus far. But, of course, they won’t cover the infusion center fee. I’ll have to ask the MS Society for help with that.

Next week, I will tell all about my adventures in procuring a new GP and neurologist, a new infusion clinic, and what my part of the cost will be for real.

1 comment:

  1. They don't call the insurance business a "racket" for nothing!
    Best of luck to you in your quest for answers.
    Keep us posted!