2 weeks ago
Sunday, March 24, 2013
“Can’t you just wait two days?” the pharmacist asked.
“So my baby should go off his medicine for two days because our insurance won’t cover us until Saturday?” I asked, feeling myself turning into Mr. Angry Customer Man.
He paused for a moment to consider an answer. To help him arrive at the right one, I tried to flex hard enough to shred my pants and shirt into tatters, but my face just turned red instead of Incredible-Hulk green.
“Hmmm, yeah, that doesn’t sound right,” he replied. “Let me call your insurance company.”
I took a deep breath, thanked him and stepped away from the counter, wondering how my wife Kara was faring out in the car with our two sons, who were surely threatening mutiny by now. If they ever figure out how to unbuckle their car seat harnesses, our reign will be over.
“This’ll just take a sec,” I’d said when I hopped out of the car, thinking that I was just picking up a prescription, not arm-wrestling the medical-industrial complex.
Leaving the pharmacy without the medicine was not an option. Kara and I are very close to celebrating our 365th-consecutive terrible night’s sleep, an anniversary that is easy to remember because, through no small coincidence, it falls on our son Zack’s first birthday.
On the recommendation of his specialist, we’d recently doubled Zack’s dosage in hopes of finally taming the reflux that has caused more lost sleep than the world’s collective car alarms and beagles combined.
Living with Zack is like living with a werewolf, and every night's a full moon. In the morning, he is all smiles and coos, a sweet child with a wonderful temperament. He has no recollection of the wailing beast he'd become during the night.
“Not again,” we’ll say when the howling begins.
The next day, he’ll crawl up to you, eyes twinkling, looking up as if to say, “Good morning! Hey, what's with the bags under your eyes, and the claw marks across your face?"
After resigning ourselves to never sleeping again, Zack’s specialist had given us hope that doubling the dosage could do the trick. Zack needed more of his medicine, not less, and we’d given him the last dose at our house that morning.
“Yes, but they had to double the dose. That’s why they ran out a few days early,” the pharmacist said over the phone, and I appreciated him arguing on our behalf.
Usually, Kara dukes it out with the insurance company, which can be a full-time job. We chose her insurance plan, and covered our kids with it, because, while being ridiculously expensive, it was one of the few plans that promised to reimburse the cost of Zack’s wickedly overpriced reflux formula.
“There’s been a mistake,” the cashier will say after ringing up his formula.
“No, I’m afraid that’s right,” I’ll say. It is the Dom Perignon of formulas. Once Zack’s off it, we’ll have to feed him pureed lobster tails just to keep up the standard of living he’s grown accustomed to.
I’ll save the receipt and give it to Kara, who will submit it to the insurance company to be rejected. Kara will call and complain, they’ll approve it and promise never to reject it again. And they won’t, until next time.
The first time might have been a mistake. The second time, an oversight. By the sixth time, it sure seems like a policy.
“Okay, they won’t cover you until Saturday, but you can pay a full month’s market price now and submit to be reimbursed,” the pharmacist said, while shaking his head as if to say, “Don’t do it.”
“Don’t do it,” he then said out loud, in case I’d missed his drift. I bought two pills at market price to get us to Saturday, at which time I’d come back to bargain again.
When dealing with medical insurance, it helps if you have good drugs.
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Posted by Mike Todd at 11:31 PM