No, We Are Not Exceptional -spoiler alert – (I am bitching about our health care insurance system)

Yesterday, I spent over 3 hours (closer to 4 hours than 3) on the phone trying to dig out of a health insurance debacle.

This tragedy started on Sunday when I went to pick up my wife’s prescriptions at the Walmart Pharmacy. The pharmacy tech asked me if I was prepared to pay over $300.00 for the scripts. I said, “No, I filled these same scripts in June and my out-of-pocket cost was just over $25.00.” She said, “Well, you are being charged for your deductible and some copays.” I said, “We would have paid the deductible at the beginning of the year as the Blue Cross Prescription Drug Plan has a calendar year and we get hit with the deductible in January the first time I fill scripts. “She said, “Well, maybe you fell into the donut hole.” I said, “No, I set up my wife’s insurance supplements so we would not have to deal with the donut hole.” She said (I know, a lot of “he said, she saids) Well, you had better call the insurance company on Monday and we are having problems with people’s insurance numbers changing.” I went out to the car and brought in Susan’s insurance cards to make sure they had the right numbers and they did.

Ok, my first call on Monday was back to the Walmart Pharmacy to ask them to run the scripts again and see if the numbers/costs came out any different – they did not. I then called the number on the back of the Blue MedicareRx (PDP) card for customer service (by the way, this number is answered out in Colorado, not in Vermont).

After lots of digging on the Colorado end of the phone (a company called CVS Caremark that processes the claims for the Vermont Blue MedicareRx (PDP) plan subscribers) I found out that all of my wife’s scripts had been going to the wrong claims processor for the last 3+ years. I was told that CVS Caremark has not had a prescription claim on my wife’s insurance since May of 2018. My wife has had this insurance for almost 6 years. I have no idea if any of the claims were processed correctly or what is going to come out of all of this. For some unexplained reason, this past July CVS Caremark got re-involved in my wife’s insurance. CVS Caremark is sending this problem to their problem research team and I was told it may take over 30 days to dig all of this out as there is over 3+ years of incorrect claims submission that they know nothing about.

I asked CVS Caremark where and to whom should I be pointing fingers at. They were reluctant to answer but when I insisted on being passed up the line to some level of supervision, I was told that Walmart is to blame.

Ok, it seems odd also that our Vermont Blue Cross would not have picked up on this??? I don’t get it. Lots of finger pointing seems to be ok here.

Alright, now the more painful part, I have to pay the deductible already paid once this year AGAIN! Why? Because CVS Caremark was not the recipient of my earlier payment of the deductible. I paid copays that I should not have been charged also. I was told that “eventually” when they dig all of this out I might be reimbursed for all of this – meanwhile, just eat it.

You know, I will be 70 years old this November. I still have enough wits and stamina to try to do combat with these insurance companies, but I worry about the day that will come when I am not up to it. How many others have already reached that day? We did nothing wrong and yet we will pay the penalty for their malfeasance. And why is Vermont Blue Cross contracting out the processing of these insurance claims? It seems like some Vermonters could have had some good jobs if this was done right here where the insurance is sold and bought.

I am exhausted once again from all of this. My last call with CVS Caremark ended last night (our time) at 7:00 pm. I know on Tuesday I have to get back on the phone with the Walmart Pharmacy and also with Vermont Blue Cross. I am not happy as you can tell and I will be all over some folks like ugly on an ape. I mean it – we just went through a different version of the same fight last month getting my wife her new insulin pump.

Over my adult life, I have waisted days, yes days, fighting with health insurance companies. This goes with the territory when your spouse has a chronic health care problem (Type 1 Diabetes). What has helped me over and over is taking good notes in my conversations with the insurance companies and insisting that the calls be recorded. More than once I have directed the insurance rep to refer back to a prior call/conversation and listen to what they told me then. At one time, the Vice President of Vermont Blue Cross wanted me to call her directly to get problems fixed. I am just tired of all of this. I don’t think it works like this in other developed countries with health care. Too many people are trying to make a profit off our health care. It makes it more expensive and nobody wants to pay if they can avoid paying.

Sorry for the rant – I am just tired and I know I have another day of fighting ahead of me. So, don’t give me that horseshit about America being “exceptional.” We are far from exceptional – not even close and losing ground all the time. (sorry for the “horseshit” language but it fits)

Published by Ed Pirie

I am a Vermonter, been one all my life. That just about tells you all you need to know. I am not much of a follower and like to do my own thinking. I value my family and a quiet existence in a very rural part of Vermont. There is a lot in the world I do not understand. My writing is my attempt to wrap my head around much that is swirling around me. Some time ago gasoline pumps changed to the way they look now. I had stopped to fill my Jeep and I could not get the gas to pump to save my life. I went inside and complained to the attendant. She knew me and said, "Ed, the whole world is changing and if you don't figure out the changes you are going to fall off the earth as it spins around." Well, I am not always successful figuring out the changes, but my writing is my way of working through some of them. I hope you enjoy.

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