Since its the advent of “open enrollment” season, Pharmacy Chick thought it might be a good time to do a piece to remind our valued customers what insurance is, what it does and good information to consider when you forget to give us your new insurance information next year, neglect to read the provided mailings and generally plead ignorance when you are quizzed by pharmacy staff when your coverage rejects on January 1.
You think I am being funny…I am not…ok, I am trying to be funny but all of the above WILL happen across the pharmacies nationwide ( as they do every year) on Jan 1.
Previous to the concept of “insurance”, if you were sick, you went to the doctor, and then paid his bill…either by some payment plan or in one lump sum. If he gave you a prescription, you took it to the pharmacy and bought it. If you had no money, you most likely didn’t go to the doctor because you couldn’t pay for it. Like other things in life, you could have only those things you could afford to own. I have no doubt that people died from things curable because they couldn’t pay a dr to see them.
Then, somebody came up with this idea of “insurance” which by its basic idea was to take a large group of people to all pitch in a small amount of money…to create a large fund of money to “fund” the illness of those who might get sick over the specified period of time. Essentially the “many” fund the “few”. Its a fair and honorable concept.
Unfortunately it became a veritable monster whose sole purpose it seems has been to sustain itself,using premiums to pay for all the employees of the insurance company ( whose jobs include rejecting claims, avoiding phone calls, and reducing benefits) instead of paying claims of the members.
Never the less, this massive beaurocratic pig is here to stay so one might as well stay informed.
So for the benefit of my huge readership ( all 7 of you) here are some pretty valuable concepts ( all given to you in laymans terms..right on the table) to help you know about your insurance. May it prove to be useful.
1. Your insurance counts on your ignorance. Read the materials they send you. Save those materials, and when they send you new cards, throw away the old ones, and make sure that everybody who provides your health care gets a copy of that new card. Keep all that correspondence in one manilla envelope marked ” 2013 Insurance info”. They are only required to inform you by mail about certain changes, they arent required to make sure you know and understand.
2. New year, new benefits. Do not assume that what you got in 2012 will be what you get in 2013, and that includes your prescription drugs. What was covered in 2012 may not be covered at all in 2013, or it may be a higher copay. Not only what is covered may have changed, but how much you can get can also change…overnight. You may have enjoyed a 3 month supply of Nexium this year, but next year you may be limited to 30 days…unless you enroll in your mail order option.
3. New year, new networks. As reimbursements change, sometimes you will wake up on Jan 1 to find out that your pharmacy ( or doctor or hospital) are no longer in your network, or no longer a preferred provider.
4. New year, new hassles. For every 10 people who wander into my pharmacy on Jan 2 with a prescription to fill and a terminated plan, 8 of them will stammer that “nothing has changed”. Trust me, it has, and giving me hell because I cannot divine your new insurance will not help the situation much.
5. New year, new deductibles: So after you have worn off that New Year’s Eve hangover, watched all the bowl games on TV and thrown out the cold smokies and warm soda left on the counter all day, remember this: its a NEW YEAR, and for many of us, including the Pharmacy Chick, the anual deductibles are back on the table. Because I have a high deductible plan, I am still working on 2012 in late October. Therefore when your Trilipix goes 10.00 to 148.00 please understand that I am not ripping you off.
6. New year, new card requirements. This is mainly a hassle for us providers. Your card might look nearly identical between 2012 and 2013 but often much changes at the provider level. Sometimes your insurance company changes WHO handles their pharmacy claims. For us, that is the BIN number…it helps us to find WHO to bill. If you have medicare D, the beaurocratic pigs in washington make miniscule changes to your cards every year that require we change SOMETHING every January to make claims submission successful. So you may have had Blue Cross of Gooberville for the last 20 years, but since Blue Cross changed your person code from 01 to 00 in 2013, all of your 2013 claims have to be submitted differently.
Lastly, remember that your insurance is an contractural agreement between YOU and THEM..not YOU and ME. I have no impact whatsoever on what is covered, what you pay, or how much you can get. Pharmacies only provide the service. I have my own contract with the insurance to provide members with drugs that THEY have agreed to pay. YOU and I have no agreements whatsoever. Its the same with your physician’s offices. If something isn’t covered, you have 2 options: pay or walk. Dont be surprised if we arent overly sensitive to complaints about price. We do not set the price and since we pharmacies endure endless complaints in January about price, after a certian amount of time, we simply don’t want to hear about it any more. Don’t take it personally. If you do not agree with a price or copay, you are not required to purchase the rx, and YOU are always free to call your insurance to obtain more information. More often than not the pharmacy will NOT have the time to call on your behalf about copay disputes.
So, dear readers, when you get your 2013 packet, pore over it like it was holy scripture. Review what you are taking now and verify it will be covered next year. Have a plan. Stay informed and have a plan B in place if the unthinkable happens.
As health care expenses skyrocket, insurance companies look for ways to save money…and they are rarely to YOUR benefit! 🙂