Who’s On First?

Who’s On First?


When faced with the choice between laughing or crying, always choose laughing.  Sometimes life gets so absurd, so convoluted and ridiculous, that it's best to throw up your hands and laugh.  There will always be plenty of time to scream and cry, but laughing nourishes mind, body and soul. As faithful readers of this blog know, I have worked hard for real health care reform.  You also know my personal journey through the ludicrous health insurance maze.  Now that it's a new calendar year, my family has begun to negotiate our way through two new health insurance plans, one for my husband, Mark, and me, and one for our son, Ethan.

Let me set the stage:  It was the morning of Monday, January 4.  Mark and I were sitting at our desks, which are only a few feet apart from one another.  We had our computers in front of us.  Mark had open in front of him two thick insurance booklets.  Please enjoy the following exchange between us.

Phyllis:  What is Ethan's deductible for prescription medications?

Mark:  Hold on, I'm checking... it's $100 before insurance kicks in.

Phyllis:  Does the $100 have to be spent at in-plan pharmacies?

Mark:  Hold on, I'm checking... no, it can be spent at out-of- plan pharmacies, but then we would have to submit the receipts by mail to have it apply toward his medication deductible.

Phyllis:  OK, let me download that form.  Hmmm... there are a couple of forms here that would work.  Not sure which one...


Phyllis:  Do his Remicade infusions [every 6-7 weeks for Crohn's disease] count toward the medication deductible, or is it a separate category?

Mark:  Hold on... there is no category for medications that are administered intravenously.  There is only a category for injections.

Phyllis: After he meets the medication deductible, how much will insurance pay for prescriptions.

Mark:  Hold on, I'm checking... checking... checking...

Phyllis:  Is Ethan's medication deductible counted toward his overall deductible?

Mark:  Hold on, I'm checking...

Phyllis:  I need to renew a prescription for myself today.  Let's see what our new policy allows, if anything.

Mark:  Hold on, let me switch booklets.

Phone rings.  It's Ethan's doctor who has spent way too much of his day writing to Ethan's new insurance plan why he must have the Remicade infusion rather than take other, less expensive treatments.  Note: this is the same insurance company as his previous plan.

Doctor:  I'm sorry to bother you with this, but I want to verify a few things with you.

Phyllis:  I'm sorry you have to do this.

Doctor:  No problem.  But this is exactly why we don't take insurance anymore.  We still have to justify treatments to insurance companies daily, but it's far less paper work than if we were insurance participants.

Phyllis:  I completely understand.

Doctor:  I'm sure it's some young kid sitting behind a desk at the insurance company whose job it is to catch any order for Remicade.  I will fax this to the insurance company right away.  Hopefully, they will approve Ethan's infusion today.

Phyllis:  That would be great.  He is already a week overdo for his infusion, and he's starting to have more pain.

Hang up phone.

Mark:  I'm still checking on our medication coverage.  It's not clear.  I put in a call to Eric [our insurance agent].

Phyllis:  What is our deductible if we go to in-plan doctors?  What if one of us goes to in-plan doctors and one goes to out-of-plan doctors?  What if we both do a mixture of in-plan and out-of-plan doctors? How is the total calculated?

Mark:  Hold on, I'm flipping pages as fast as I can!

Phyllis:  I'm looking at all of this online, but it's not clear if we each pursue different combinations of in-plan and out-of-plan doctors.

An hour has passed since this conversation began.  Phyllis and Mark look at each other and break out in laughter.

Mark:  I have to get some work done.

Phyllis:  Me, too.

Three hours pass.  Still waiting for an "ok" from Ethan's insurance company for his infusion.  Still not sure about the various combinations of deductibles for Mark and me.  Still don't know if Ethan's Remicade counts toward his overall medication deductible.

Mark:  I'm going to clean out the basement.

Phyllis:  I'm going to write a blog.