The Joy of American Health Insurance

Two days ago the employees in my organization entered our annual health insurance open-enrollment season. While this has always been a pain in the butt process, it assumes greater importance given my current situation. Considering that I have 22 weeks left to complete my course of Hepatits C treatment, continuity of care becomes an issue of primary importance.

I currently have Blue Shield insurance. I enrolled in Blue Shield when my organization’s health care broker dropped my previous insurance company. This year, they have dropped Blue Shield from their list of available plans. They have substituted Anthem Blue Cross, one of the more notorious insurance companies in the country and Healthnet, one of the most expensive. Just the sort of additional stress one looks forward to at this most wonderful time of the year.

I am currently enrolled in an HMO under the Blue Shield umbrella. This is not an HMO in the traditional sense of Kaiser Permanente or Group Health; that is a company that owns it’s own medical facilities. Instead Blue Shield contracts with physician groups and hospitals that provide the same services as a HMO. My physician group is associated with both Blue Shield, Healthnet and Blue Cross, so I should – emphasis should – be able to transfer my care over to one of the other umbrella payment plans without a great deal of difficulty. Even if that is the case, however, there is no guarantee of consistency in the drugs each organization has in their drug formularies and particularly in the amount of co-payment they charge for the more exotic drugs necessary for treatment: Pegasys (interferon), Neupogen, Procrit and Ribavirin. Currently my co-payments for these bad boys run about $315.00 per month. Will the number go up, down, sideways? Inquiring minds want to know.

I have begun my research, of course. I have a series of questions in to my HR department, such as it is; I have called my specialty pharmacy to initiate inquiries as to their knowledge of co-payment differences; I have talked to my doctors about the necessary paperwork I will have to produce to ensure that I will have uninterrupted care. Oh yes, I have ten days to make my decision.

Would that our country was a sane one and health care was viewed as both a necessity and something citizens could expect from the taxes they pay. Thank heaven I at least have an employer that provides health insurance plans or I might be living in a box right now – the actual retail cost billed to the insurance company for the drugs I take on a monthly basis is just over $7,000, quite a bit more that I make in pay.

Soon enough information will come pouring in and decisions will be made, I can hardly wait for the conversations with insurance functionaries, Joy To The World, eh?