Medical Costs Rise….. My Own Experiences

Above is a link to an article in today’s (2/1/2015) NY Times. It got me thinking about my own experiences in regards to the rising cost of Health Care. This will take me a couple of days to write as I need to contact my Insurance Company and they are closed today so hang in there.

This actually begins about a year ago. My wife has, for seven years, worked in a school as a Special Education Aid. In June of 2013 we were told that they were going to cut her hours from full time to twenty five but that for one last year she would be allowed to participate in the School System’s Health Coverage Program. Which I might add was very good. But that to do so she would have to contribute to the monthly premiums. Let me add here that the District was asking everyone to also pay into the monthly premiums for the first time so her job was not alone in this. The premium was low enough so that did not bother us. What really hurt was the loss of income. This was a major cut especially since I was dealing with work related health issues that I cannot go into here because of ongoing Litigation.

I work in an industry that supplies products to retailer stores. Most of my retailers have told me that they will no longer be hiring full time employees and only part timers (at about 25 hours a week) because of the new Affordable Health Care Act and it’s ramifications.

Now let us move ahead to the summer of 2014. Although my wife’s coverage wouldn’t end until August 31st I began to look at various options open to us. The company I work for used to have GREAT insurance but since I hadn’t needed it for seven years I had my homework to do. As it turns out, the premiums were constantly on the rise, and the types of coverage were constantly changing. At one time were able to pick from three tiers of coverage depending on our family/personal needs. Of course each had different monthly premium costs but that was to be expected. By 2014 there were still some choices but not as good, and of monthly premiums were up as well. The best one that I could find was a $3,000 family deductible but prescriptions were in three tiers. The tiers ranged from $50 to $15 per month for a prescription depending on what kind of medicine it was. Okay so far, as prescriptions were concerned it was up from the tier program that my wife’s insurance had but not by that much. But, now instead of a $15 copay for a Doctor visit (yes I know that that is very very low, but remember that her insurance was through a Public School System) I now had to pay full price until the family hit the $3,000 deductible. Not wanting to feed the deductible for the last quarter of the year, we all changed our existing appointments to the beginning of this year.

November 2014, open enrollment time. Holy Shit!! My Company now cut our benefits even more. No longer did we have three plans to choose from, now we had only one. And here it is: The premiums pretty much held, the family deductible stayed at $3000 for the family and, (are you ready for this?), now any copay for prescriptions doesn’t kick in until we hit that $3000 deductible. Then  it was an 80/20 copay based on a three tier system.

I looked into the Affordable Health Care act and it would cost me $1800 a month in premiums and not much better in deductibles and prescriptions costs. Before my wife’s policy originally ran out I checked Cobra and that was going to be $2800 a month but the coverage was still really good. But who has $2800 a month to shell out for premiums, and remember that because of the A.H.C.A. we lost a chunk of monthly income because of her hours being drastically cut. So as you can guess we hung in there with the insurance offered by my employer and started an Health Saving Account with what little I could afford and prayed that my employer would not cut their contribution to it.

I happen to take about seven types of prescriptions for various reasons. Some because of my genetic make up and others because of my genetic make up. (Yes you read that right). One prescription that has always been in the highest tier came up for renewal last week. I went to CVS and it came to $542 under our new plan. I did not bring it home. I went home, logged onto the manufacturers website and applied and received a discount card which brought it down to $252 a month. HOLY SHIT.  Well that was yesterday. Tomorrow, Monday I am going to call the insurance company, which won’t do much other then make me feel like I gave it the ‘All American Try’, then the Pharmaceutical Company that makes the medication and see if they can do better for me, and lastly put in a call to my Physician and if necessary see if something else exists that will cost me less a month. So hang in there, I will be back momentarily, in print time, with an update.

Monday February 2, 2015:

Here is the update. I called UMR (our Insurance Carrier and a division of United Health Care). They were very nice but all they would do is reiterate what I wrote above. They did suggest that I call OptumRX the company that deals with prescriptions for them. Which I did. They told me that under our NEW plan the fees were correct and that there was nothing to do except call the prescription discount card people that I downloaded. They were also very nice but said that the fee was correct based on the Parent Company’s policy. Next it was suggested that I call the Pharmaceutical Company itself because they have a Patient Assistance Program. [You see where this is going, right?] Well under their guidelines, and looking at our current W2 forms, we make too much to  be considered for their program. Not a lot more but still too much.

So there it is, I have said it for many years now. Insurance is going to break the backbone of this once great Country. Blame it on Obama Care. Blame it on Congress. Blame it on anything you like, but a run away freight train will still, eventually derail and cause a major accident. And that is what we have here.

Well tomorrow I will call the Doctor and see if I can get some samples to hold me over until I figure out this whole mess. I will keep you all posted.

In the mean time: “Attica, Attica, Attica!!!!!!!!!!!” Google it youngun’s.

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