Adventures in health insurance

injecting a vialIs it ever better to NOT to use your health insurance? You betcha.

Readers who’ve been with me for awhile are aware of my past with health insurance. There was a 4‑year period a few years ago when I went without health insurance, so I’m acutely familiar with its blessings and curses.

I learned, for example, that every single entity involved in the industry of healthcare will offer you a 30% discount if you pay cash. Why? Because it’s cheaper than dealing with health insurance companies. You want to know why healthcare costs are so high? Health insurance.

I had a new experience yesterday that I want to share, because I’m sure it will one day benefit somebody else.

I have an extremely low testosterone level (68) and have been working with my urologist to find a suitable treatment. It’s one of those tricky areas with a lot of options, nothing of which has really helped raise my level sufficiently to get my energy level up. Low T is a joke until you have it, and mine goes beyond what’s typically known as “male menopause.” I’m 64, for crying out loud; not dead.

So I take regular testosterone shots. My insurance provider covers the medication somewhat, but the “program” has restrictions on how much I can get at one time, so let me explain the dilemma and the solution I discovered with my pharmacy.

My doctor’s prescription is for a 10 ml vial of the medicine. I’m supposed to take 1 ml injections every other week. The policy, however, will not permit me to obtain more than a 30-day supply of any prescription, so the pharmacy has to give me two 1 ml vials, and those can be hard to come by. Generic versions often are not available, so I have to buy brand name, and I have to order it ahead-of-time. With insurance, the brand name vials cost me $50 out-of-pocket, or $25 per injection. Steep.

My doctor says this is nuts and that I’m the only patient he has with this problem, but there’s nothing he can do. I went round and round with the insurance company, but then my pharmacist, Joel, said, “Why don’t you just buy the generic 10 ml vial without insurance?”

“What? Without insurance? Are you kidding me?”

Turns out he wasn’t. The generic version in 10 ml is $95 without insurance, so I saved $155 out-of-pocket by NOT using my health insurance.

This business of not being able to obtain more than a month’s supply of drugs through insurance really needs investigation. Doctors trying to save people money by letting them buy a 3‑month supply are cut off at the knees, and when this kind of nonsense happens in our culture, there’s usually somebody benefiting financially. Who would that be in this case?

The doctor? No. The pharmacy? Not likely. The insurance provider? Perhaps. The drug manufacturers? Hmm.

I know I bitch a lot about arbitrary rules in our culture, but this is one of those times when I think it’s justified. When industries that deal with consumers create rules with no wiggle room or exceptions, humanity itself suffers, and we fall deeper into the cold abyss of black and white, win or lose, all or nothing, and so forth.


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