I’m fortunate.
When I was laid off from my job last month, I was eligible for continuation of my health insurance. I have enough money saved up that I can pick up the large portion of the premiums that used to be contributed by my employer. I was persistent enough, and knowledgeable enough, to navigate through the shoals of bureaucracy that lay between employer-based and formerly-employed insured status.
It was frustrating for several weeks. For instance, I wasn’t allowed to apply for continuation coverage while still insured. Then I couldn’t write a check for the first month of coverage until my application for continuation coverage was received, processed, and accepted. It took over a week after my check was deposited before my status was updated from no coverage to insured. Even after that change was acknowledged, it required a call to the PBM (pharmacy benefit manager), a business separate from the insurer, to update my prescription insurance.
When it all settled out, the insurance was reinstated retroactively to the first day of the month. But I still had to make sure that the claims rejected while I was in limbo were resubmitted (I haven’t yet contacted the lab that drew and tested a blood sample). Every one of those steps wastes money—customer service operators who could have helped someone else, clerks who had to open, photocopy, and file my applications, eligibility assessors who had to process my paperwork, personnel at my providers who had to send my claims to the insurer for a second time, computers that had to rerun those claims. It was only a little bit of money each time, but of course those infinitesimal amounts add up to big bucks when multiplied by thousands or millions of incidents. At least I get my EOBs electronically, so I didn’t kill many trees by generating all those papers twice.
My office visits and lab tests hadn’t made it through the providers’ billing systems by the time I became retroactively covered, so they had no visible impact on my wallet. Because the office personnel don’t know the alleged prices of their services, they probably couldn’t require up-front payment anyway. Not so when it comes to prescriptions … I had to pay the full retail price before I could get my medications. Once covered, I went back to the drugstore to have my credit card reimbursed for the cash I’d laid out.
As it happens, I take six “maintenance medicines”, prescriptions that I refill every month. All six are generics, costing appreciably less than the brand name versions of those medications. Even so, the full retail price of a month’s-worth of my meds was rather hefty — $445.74 (brand names would have run $864.67). After my coverage was restored retroactively, I went back to Bartell so that they could resubmit the prescriptions to my insurance. After applying the (appreciably lower) price negotiated by the insurer, and after accounting for the portion of that price paid by the insurer, my out of pocket cost for those six prescriptions came to just $11.98. I have very good insurance.
Similarly, were I not insured, the price of an office visit would be $219.00. My insurer had negotiated an allowed amount of $83.01 for that sort of visit, only about 38% of the alleged retail price. And my out of pocket portion of the insurer-negotiated price comes to a mere $12.45. To reiterate, I have very good insurance.
I knew it would work out as it did. And I had the resources to ease the difficulties of the bureaucratic delays. But suppose I didn’t have a credit card. Suppose I lived from paycheck to paycheck, with only a debit card and a meager bank account. Then, I would have had a problem. Then, I might have been required to choose between maintaining my health and buying groceries, or maybe even between medicines and rent. Forced into such a dilemma, filling prescriptions would undoubtedly fall behind food and shelter.
Being unemployed and uninsured, then, is a double triple-whammy:
- You have much less money coming into your bank account
- The bill for healthcare services is much larger than what an insurer can negotiate with the provider
- You bear responsibility for paying the entire bill
I could go on. I could mention the uncertainties faced by providers; because of the myriad insurers with myriad rules and myriad methods of bill submission, they never know how much they’ll actually receive in reimbursement for their services (and they must hire additional staff to handle all those procedures). I could argue for something like Medicare for all, or for a sensible healthcare system like those in civilized nations (there are many models to choose from, all of which are better and less costly than ours).
Instead, I’ll just thank my lucky stars that my layoff isn’t the kind of financial and health disaster that it could be if I didn’t have resources. And I’ll pay my insurance premiums every month.
[Cross-posted from Peace Tree Farm]
Bartell’s is a RIPOFF! My girlfriend doesn’t have any insurance at all, and she got some discounted care at a Sea-Mar clinic. They recommended she go to Bartell’s to fill the two prescriptions they gave her. Any, she calls me, and says that Bartell’s want $73 for filling both of them. I recommend she either contact Costco or Wal-Mart. Anyway, Costco wanted a total of $21 something, while Wal-Mart wanted $6 for one and $4 for the other — total of only $10!
People say a lot of horrible things about Wal-Mart, but they fill a much needed niche in our economy. Wal-Mart gives relatively low wages to their employees, but they also try to market things that are affordable to the lower income people in our society. Bartell’s rips off the poor and uninsured, by charging them seven times a fair retail price for prescription drugs when they don’t have insurance. Wal-Mart charges them a fair price (and of course still makes a fair profit) that is only modestly higher than what they get the drugs for at wholesale.
I challenge you to compare, for your six monthly maintenance medications, the following prices:
1. What Bartell’s would ripoff a poor uninsured person at their so-called “retail” price.
2. How much Costco would charge a cash customer without insurance.
3. How much Wal-Mart would charge a cash customer without insurance.
4. The price your insurance company actually negotiated for each of the drugs.
Best insurance in the world. USA-fukkin’ A!!!
Sorry to hear about your layoff, N. You’re right about your insurance — it could be so much worse. COBRA is government intervention of the sort conservatives despise. But in your situation, you should be very happy that you’re not entirely at the mercy of market-based solutions.
I’m not against capitalism or free markets. They have a place in the scheme of things. But market-worship, like hero-worship, can go too far. Like Joe Paterno and Bernie Madoff, markets are flawed, and placing too much reliance on them is dangerous to your well-being. A good insurance policy is never a bad thing to have.
@1
I generally think that Wal-Mart is a malignancy on society, a reprehensible machine for fleecing employees for the benefit of the billionaire Waltons. They fleece the rest of us as well by paying so little that many of their serfs require public assistance.
However, I have had a similar experience to yours. One of my patients several years ago, an organ transplant recipient, could not afford his anti-rejection medications, with are horribly expensive. He did the legwork and found that Wal-Mart had them for (IIRC) about $5-10 each a month, rather than hundreds. I don’t know how they do it, but it saved his transplant, and staved off much more expensive organ failure.
@1
Target’s pharmacy is pretty bomb as well. When my sister had a prescription that was going to cost her $80, the WORKERS in the pharmacy got on the phone and called around to other pharmacies so they could get a lower price to match theirs too. They cut my sister’s bill in half.
From what I heard, it sounded like management didn’t like their employees doing this, the customer was supposed to find the lower price, but that the workers in the pharmacy did it on a routine basis.
We used Target when my sister had ovarian cancer and they were always up on things and did great.
@1:
Richard, I can’t quite give you everything you request. Wal-mart tells you which meds are in their $4 prescription list, but won’t display prices for those that don’t make the list. However, I did find something beyond what you want — what my insurance would pay at Costco and Wal-mart. Actually, Costco’s insured-price is exactly the same as Bartell’s, so I won’t display it; Wal-mart doesn’t match the other two.
For the insurance prices, I present the information as ($insurance portion + $subscriber portion) = $negotiated price.
Drug B:
Bartell insured = ($43.98 + $4.89) = $48.87
Wal-mart insured = ($45.11 + $5.01) = $50.12
Costco uninsured = $29.21
Wal-mart uninsured = ???
Bartell retail = $188.89
Drug H:
Bartell insured = ($2.72 + $0.14) = $2.86
Wal-mart insured = ($3.90 + $0.21) = $4.11
Costco uninsured = $6.30
Wal-mart uninsured = $4.00
Bartell retail = $10.99
Drug L:
Bartell insured = ($16.63 + $0.88) = $17.51
Wal-mart insured = ($17.82 + $0.95) = $18.77
Costco uninsured = $7.18
Wal-mart uninsured = $4.00
Bartell retail = $88.19
Drug M:
Bartell insured = ($7.41 + $0.39) = $7.80
Wal-mart insured = ($8.60 + $0.45) = $9.05
Costco uninsured = $5.69
Wal-mart uninsured = $4.00
Bartell retail = $33.79
Drug N:
Bartell insured = ($58.48 + $6.50) = $64.98
Wal-mart insured = ($67.86 + $7.54) = $75.40
Costco uninsured = $37.69
Wal-mart uninsured = ???
Bartell retail = $86.89
Drug S:
Bartell insured = ($4.76 + $0.25) = $5.01
Wal-mart insured = ($5.95 + $0.31) = $6.26
Costco uninsured = $13.50
Wal-mart uninsured = ???
Bartell retail = $36.99
For people with my insurance, Wal-mart is more expensive than Bartell/Costco. For the uninsured, Wal-mart’s $4 program is the best deal if the med is on that list. No idea how they compare with Costco for the others. The Costco-uninsured price is higher than the Bartell/Costco negotiated price for drugs B and S, lower for the other four.
Bottom line — if you have insurance, it doesn’t much matter where you go (though Wal-mart is the worst of the lot). If you’re uninsured, the $4 program at Wal-mart (when applicable) is a godsend, while Costco might be your best bet for other meds. Bartell probably anticipates that just about all of their customers have Rx insurance.
@Richard Pope: not sure if Walmart is a valid comparison, given that they’re receiving significant federal subsidies in the form of the safety net benefits that they encourage (and underpay enough to enable) their employees to collect.
Personally, I’d prefer to just subsidize the goods directly – at least that way, I’m not lining the pockets of smug Christianist assclowns like the Waltons.
I gotta ask… Why are you so sick?
I’m all for national health care. I don’t think the ACA went far enough – the greedy insurance pirates should have been nationalized outright. We should have single payer.
But why are you so sick?
I have insurance but I don’t have a use for it. I’m not sick.
Why are you so sick?
@9:
How old are you? I’m 61.
Among my meds are some that control hypertension, hyperlipidemia, and Type 2 diabetes … chronic diseases that are quite common among those of us in the second half of our lives.
The drugs I take help to keep me healthy. Would you rather I stop them and require vastly more expensive inpatient procedures?
@9:
Remember that you don’t necessarily need to be sick to use your health insurance. Ever had an injury, busted leg, thrown your back out, been in a car accident [or if you’re in Seattle, been hit by a bike while strolling Burke_Gilman]….these days a busted leg goes for about 10-15K.
At 66 I’ve been pretty healthy all my life except for several bouts of malaria and one of cholera as a kid. Last year I had to retire, no energy, unable to keep up at work, yada, yada. After a lot of expensive poking and prodding I’ve got lupus which destroys my red blood cells…..you got 300 million, I got 40 million. Apparently quite rare in old, white, men so nobody looked.
Fortunately I had decent insurance for which I had [and my emp[loyer had] paid for years. This year I switch to Medicare. We’ll see how that goes as I also moved from Las Vegas to Keller. The facilities here are a little more basic but part of the Washington Community Health Clinic system so I’m not excessively concerned.
I rarely ever use up the deductible on my insurance, but when I do use it up I use it up good.
When I busted my leg, with the 5 day stay in the hospital, physical therapy after the break, 2 years later removing the pins and plates they fixed the breaks with, the over-night stay in the hospital from the removal, and a little more post-surgery PT you’re looking at about $30K.
Last year my spleen started swelling up for no reason that anyone could find and boy did they look. I had every blood-test known to man, an ultrasound, CT scan, consults with about 3 or 4 specialists, not sure what that ended up costing. In the end they said I’m really, really, healthy and that sometimes spleens just do that. It sounds like we know more about the planet Mars then we do the human spleen.
Keller’s way prettier than Vegas.
@6 Kinda tells you what the profit margin on Rx’s is, doesn’t it?
@9 “I don’t think the ACA went far enough – the greedy insurance pirates should have been nationalized outright. We should have single payer.”
That’s why Roberts voted to uphold ACA. He knew if it fell, the next step was opening up Medicare to everyone — i.e., universal, single payer, government-run health insurance.
N in Seattle,
Normally you and I don’t see anything eye-to-eye, but as I am compassionate, let me suggest a lifestyle change, that may not be too late for you. Watch this video, and then try to live the life Joe recommends. Watch the whole thing for free on the right, don’t have to buy anything except the things suggested. Now I bet Lib da schmuck will say something stupid (as he normally does) but try it for 10 days first. If necessary eat a little. Then try it 20 days. What I want you to do is to look at Joe when he started and then look at Joe CAREFULLY years later. I want you to be around a long time to get politically slapped by me whenever necessary. That will only happen if you can change your body.
Really Roger SENILE Wabbit? Single-payer? What a joke post! ObummerCare was upheld as Roberts said, it’s a tax and representative government should be the one to uphold or kill it.
N in Seattle @ 7
Excellent work!
Shows just how ridiculous our nation’s health care system is.
“…the greedy insurance pirates…”
This begs the question of why we need the insurance principle to pay for health care. Why, exactly, is it necessary for us to have to use insurance as the method for paying for health care? Could it be that health care professionals think their services are deserving of high fees, or that phamaceutical companies are gouging the public?
I think our fundamental problem with health care is that we have wonderful technology companies and people that are demanding exhorbitant prices for their goods and services. There may be “greedy insurance pirates,” but there are also greedy docs and others trying to get as much as they can from the public.
Fundamental conservative principles that show the current R health care reform opposition to be either ignorant, insane or evil:
Actual conservatives (vice the glibertarians who control the R party) understand the concept of the ancient conservative economic notion of natural monopolies as an inherent government role. Health care is a natural monopoly. It’s why Euro cons support their nationalized systems.
Actual conservatives (ditto) support lean and efficient delivery. Why should we pay someone exorbitant profits to write a check to a provider? Why would we allow a business model that relies on denial of service as a profit center? Private for profit insurance is the epitome of waste in a LEAN observant system.
Actual conservatives (ditto) aren’t greedheads and are pro-life but don’t believe government has a role in the decision. The naked greed in our health care system (even after Obamacare) kills and maims — and not just in a physical sense. Definitely not conservative.
Single Payer is the conservative health care position if one actually had conservative, you know, principles.
@20:
You’ve reminded me of what I see as the principal contradiction in today’s bankster economy, where buying and selling businesses has replaced making and selling products.
Romney and his ilk operate by creating companies and subsidiaries (and sub-subsidiaries), laying off essential functions onto contractors (and sub-contractors), ad infinitum. At each step of this bewildering and interlocking process, the “capitalists” charge small-percentage fees, taking some portion of the money in the deal for themselves. The more paper companies and the more handoffs between/among them, the more money ends up in the hands of the paper-shufflers … and the less remains for the producers and creators of the product (by which I mean workers and labor, not “job creators”).
What happened to the business tenet “cut out the middleman”? The banksters, who have made the US economy into one where finance is more profitable than production, are nothing but middlemen upon middlemen upon middlemen. They create nothing except inefficiency, supposedly the antithesis of success in a free market.
Join the Club N in Seattle.
Americans overall are not as well off today as they were when your guy took office.
Here is what Obama wants to desperately avoid discussing.
http://www.facebook.com/photo......38;theater
So, yeah, it sucks to be laid off. You didn’t tell us where you got laid off from & why?
Could it be that the economy SUCKS?!!
Lots of Republicans are former Democrats who have been fucked by anti-business Democrat rule.
@20, 21
It’s like friction in a physical system – a little bit of the energy input is expended/wasted as heat. The more moving parts, the more friction.
Can’t violate the laws of thermodynamics.
These guys are like friction, and the more moving parts there are, the more opportunities for lost energy – their fees – so that the bigger and more complicated and more inefficient the system, the more money they make.
It’s a perverse counter-incentive system in which everyone but a very few parasites loses out, and the parasites get fat.
Puddy–@16
Excellent video. I have a good friend with Type 2 diabetes and with a complete transformation of lifestyle is doing wonderful today. He lost 75 lbs., changed his diet using mainly a Juicer and hired a personal trainer 3 days/week and works out 3 more. Takes Sunday off.
Type 2 diabetes usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way.
Are you overweight N in Seattle??
Do you do everything in your control?
Many people I know with Diabetes simply do not change their lifestyle.
Seems like you didn’t care much about cost to your insurance company before. You should have cared long before this. Golden Insurance Programs causes a disconnect, like these meds are nearly free. They aren’t. Someone pays. The ObamaCare solution will make this disconnect even worse. Free stuff rarely is treated respectfully and honestly. That’s why Big Government solutions always fail in the end and are unsustainable, like Medicare & SS. Folks are pulling out way more than they put in and the Obama solution is to have rich people make up the deficit. Silly and unsustainable.
N in Seattle–
If you are more than 10 lbs. overweight with Diabetes, shame on YOU! If you eat things Diabetics aren’t supposed to eat, shame on you again! Hopefully that isn’t the case. It’s a sore subject for me because I end up paying for a lot of self-destructive people and I’m sick of it.