Thursday Thoughts ~ 8/31/23

Title: Are You Sitting Down?

This story requires background. While complicated, I will try to be brief. LuLu had surgery, we paid in advance more than our out of pocket maximum. Bills were delayed making it appear we had not met the deductible. I was fighting to get bills expedited so additional treatments – six month check up for me & a sonogram of my gut would covered. I also wanted to get my brand name prescription which I’ve been taking since 2003 at 10%.

After much back I forth, I gave up. I had no choice but to wait for bills to roll in. I got a call late in the day Tuesday where Lupe walked me through why I had NOT met my deductible yet. Turns out the two procedures LuLu had were covered at 100% for a very sad reason but still they were fully covered. I learned that there is a freaking list of what specific medical procedures get a paid in full exemption. I will get back everything we paid. This refund will take about 30 additional days for all the associated bills to settle but still a big fat check is coming back to us. In the meantime, since I haven’t met my deductible on paper, I will pay for my services like a good little girl.

The funny, not funny part is we are still part of a broken system … While I was negotiating my cost for the medicine, I was told there was an override that could be given at any time for any reason. Surely you jest I thought but in one of heated conversations I said “I WANT THE OVERRIDE while you research that I met my deductible & then some!!!” I got a voicemail on Tuesday before I had talked to Lupe to know we had NOT met the deductible. This message told me the override was granted. I had no idea what they were talking about but I called CVS.

Me: Hi, I got a message my RX is ready, something about an override.

Tech: Yes, Jill!!! We got a confirmation too! (she knew who I was without me saying my name because of all the kerfuffle we went through during the week)

Me: They approved $75?

Tech: Are you sitting down?

Me: I sure am!

Tech: Your cost is $3.

WTF! But Yay! This medicine is priced at $100 per pill. With Insurance, the 90 day supply is $746.46. I was prepared to pay $75 or @10%. The override that no one knows about but that can be granted anytime if you just go a little crazy & keep repeating yourself <I met my deductible, I met my deductible, I met my deductible> brings that to $3. Oy Vey!

For a half second, I felt guilty but nope. I’m over my shame. So what that two hours later I learned that I had not met my deductible which was the basis for my entire argument? Good Lord, I’m exhausted.

Don’t judge me puhleese, I will “pay” for this $3 discounted price some other way. If you made it to the end, you win a virtual hug. Thanks for listening.

As always, more to come.