Thursday Thoughts ~ 5/6/21

Time for another edition …

So far so good regarding the prep for tomorrow’s procedure. In fact, better than I remembered since I have been down this road twice before. Thanks to the awfulness that is health insurance, I took a new kind of prep. And that will be the topic of my Thursday thoughts.

Originally the insurance declined to cover my prep med. They said it required pre-authorization from the doctor. I called the doctor’s office and they said “that is ridiculous. we don’t preauthorize medicine”. Had I just said screw it, I would have paid $$$ out of pocket for the declined solution.

But, I called and talked to people to find out why they would do something that stupid. The insurance parent of Aetna called CVS Caremark the child. What a family affair! Finally the doctor’s office called the insurance company. And found a suitable substitute. As I was brought along for the ride in this dialog, I asked “what’s the cost; is that why you won’t pay?” The original RX was $133, the one they approved was $166. Hmmm, that theory was blown. Except when I googled the new RX, big as day across the banner of the landing page was the following statement “Exclusively sold Aetna/CVS” What the everloving hell???! It is ABOUT money. Always and sadly.

And who pays? All of us. And what about people without insurance or crappy insurance? Seriously! What about them Meredith Grey!!

In other news, the procedure itself costs close to $2000 when you add in gastro-doctor, anesthesiologist, and facility. I paid in arrangements out of pocket because I have yet to meet my deductible. BUT in 2018, when I had the exact same procedure as preventive instead of follow-up for firm diagnosis, the insurance covered the entire thing! Yep, deductible not met then either but preventive covers all.

The true cost is absolutely the same regardless of why something is being performed OR it should BE. Because I am pretty sure the insurance didn’t pay almost 2k last time. What a crooked slimey process.

And with that, rant ended. Hope to see you on the other side sometime tomorrow afternoon. Until then, hope all is well in your corner of the world.

As always, more to come.

10 thoughts on “Thursday Thoughts ~ 5/6/21

  1. That’s insane, and so very typical. I used to work in medical billing for a hospital (and a few other places). The insurance “system” and the medical *business* system is so screwed up, and really needs to be burned to bare earth. Medicare for all ain’t a great solution but right now its the best one we’ve got. Maybe in someone else’s lifetime.

    Liked by 1 person

  2. Wow, also interesting is why the prep for probably the same procedures are so different. My hubby just had colonoscopy and had to drink the “special liquid” take some Miralax and Gas-X pills, all were covered by insurance – we have Kaiser. I think he had to pay a copay but it was only $25. Maybe it is because we are old and have Medicare?

    Liked by 1 person

    1. My special liquid was covered 100% without copay since my doctor’s office changed the prescription to the deal CVS & Aetna cooked up. Medicare is different than Aetna who is different than UnitedHealth and so on. They have middle men negotiating and keeping costs down. Denying claims. In network vs out of network and all the rigmarole = one screwed up system. But I’m grateful even with having to pay so much. I have to remember we picked the highest deductible plan. Better to pay the doctor when needed then an insurance company just in case. I can’t imagine not being covered at all.

      Liked by 2 people

      1. Good point! I never looked at the deductible that way, although we have been SO fortunate that my hubby is a union man and had excellent coverage for the whole family the entire time he was working.

        Liked by 1 person

      2. Same with my dad back in the day. And my father in law too. Union men with great insurance coverage. Our insurance isn’t awful, we’ve got two choices. I took the cheaper route not expecting to use it.

        Liked by 1 person

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