When Health Insurers Practice Medicine

2019 was not the best year for me

In the middle of the year, I had to change employers, which meant new health insurance. I have a family member who has some health issues which require expensive medications, so we normally meet our deductible a few months in, finish up our copay a few months after that, and pay nothing at all during the last few  months of the year.

However, in 2019, getting new insurance meant that my deductible reset to zero in the middle of the year, and I had to start paying full price all over again, which cost me thousands of dollars in unanticipated costs. As if that was not bad enough, the new health insurance was not only about twice as costly as the old one.

This new insurer was truly horrible. To save money, they kept refusing to cover the brand-name medications that has been prescribed , and replaced them with cheap generics that were often ineffective. One such medication is Singulair, a Brand-name asthma medication that is seriously expensive. The generic did not work, so I had to pay full price for the brand-name medication. This had never been a problem with the old insurance company, but the new one kept refusing to cover medications that we had been using for years, and generally giving us the run-around. To add insult to injury, they insisted switching to three-month prescriptions in the middle of December, knowing that we would be on a new plan on January 1st. And they wanted $600 for a three -month supply of Singulair. It was cheaper for me to pay out about $250 for a one-month supply of Singulair that was not covered by Insurance at all. As they say in England, “Merry Bleedin’ Christmas”.

On one of the many occasions that I was forced to call them, I was told that several different generic versions were available and that we should try them and find one that works. I am reluctant to do this; my family is not a beta-testing lab for an insurance company looking for ways to save money. If they want us to do their quality assurance testing for them, they should be paying us for the privilege, or at the least, providing us with free samples. For those who believe that generics are just as good as brand-name medications, I recommend that you do some research; at the very least, check out a book called: “Bottle of Lies”

I keep getting phone calls and junk mail informing me about various telemedicine and telehealth services, in which I can get in touch with Doctors and nurses via the telephone or Internet 24/7. While this is a wonderful idea that will become more and more prevalent over time, I am not comforted by the fact that this service is provided, not by healthcare providers, but by my Health Insurance company. In my opinion, this is a conflict of interest, as their primary goal is not to provide better healthcare service (which is not their job; they are an an insurance company, remember?), but to reduce, minimize and eliminate claims.

Bottom line: Health Insurance Companies should not be practicing medicine; they should stick to paying claims.

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