Baldies' Blog began originally in the UK by a 26 year old journalist with a blood cancer on a mission to inform the world about bone marrow donation.

He has since died, and I took on the cause of making cancer care more transparent for everybody.

Cancer is a disease that will touch everybody through diagnosis or affiliation: 1 in 2 men will be diagnosed and 1 in 3 woman will hear those words, "You Have Cancer."

I invite you to read how I feel along my journey and
how I am continuing to live a full life alongside my Hodgkin's lymphoma, with me controlling my cancer, not my cancer controlling me.

I hope that "Baldies' Blog" will prepare you to handle whatever life sends you, but especially if it's the message, "You Have Cancer."

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Tuesday, August 25, 2009

Medco: Putting Money In The Middle of me and my health

I was getting depressed, seriously depressed.

Last weeks chemo hit me harder than I anticipated and I was really wondering if the couple days of health was going to be worth the week and a half of misery.

There was certainly a lot of misery, but I eek out the good where I can.

But you know what finally brought me back to reality and dragged me out of my misery?

A phone call from Medco.

I have written about Medco before.

Medco is my mail-order pharmacy.

I have to use Medco, because my insurance company says I do.

I would really prefer not too.

With medco I have to anticipate what I need in advance to order it so it arrives when I run out. It’s not simple. It’s not conducive to changing medications. It’s really just making my life all around difficult.

I just want my medicine.

Do you think, in my condition, I can organize all twenty of my medications to make sure they arrive EXACTLY on the day I need when they need to be ordered A MINIMUM of 8-10 days in advance.

I just want to hit the pharmacy.

I say “a minimum” because Medco has to confirm the prescriptions with my Practitioners.

First of all, the insurance company is calling for prescription orders?

How and when did they become involved in the prescribing process? Ideally, shouldn’t I be receiving the medications I need?

Adam, the representative, actually stated that I could call to expedite the process.

To start, I actually tell Medco what I want, and then they send a message to the office for an “official” script.

I’m sure if I could just order it myself from my bedroom they would accept that.

It would certainly cut out time and time is money.

But that hasn’t been worked out quite yet. I still need actually need a prescription.

The Practitioners still need to be involved.

Ironically, My scripts are from 4 different practitioners!!!!

So somewhere between dying and enjoying my life I’m going to find the energy to call all four different people and ask them to please take time out of their busy schedule saving lives to bow to medco’s demands…….

Which they will, I need my prescriptions.

If I don’t Medco sends a message requesting they write a script for, let’s say, Acyclovir 400mg TID (Three times daily) for 90 days.

Maybe this wasn’t exactly what my doc wanted to order, maybe I’ll be off of it in 20 days, but this is what my insurance will pay for, if I take their good handwritten prescription to the pharmacy for a dose in the amount I actually NEED I risk complete NONPAYMENT.

Or, even better, is as the case of my lexapro, if the company makes some special business deal with the manufacturer of a very similar but not quite the same drug like, like maybe Celexa, then that’s all well and good, they can write that prescription.

Their not getting in the way of the doctors, but I’ll just have to pay $120.00 for the three months for my lexapro instead of $20 for the celexa.

But it’s my choice.

I can’t believe I have tallied up millions in health care costs and I am still battling over anti-depressants.

Anywhere they can squeeze a cost.

This is probably why Businessweek or Forbes or someone called them the THIRD best new company in the US screaming and hollering for people to invest in a recession.

Illness is big money. People will always need medications. It’s recession proof.

Obviously,The Practitioner, for the good of the patient, sends them whatever they ask for, as dictated by Medco (i.e. must be ordered in 90 day intervals for a period of one year).

I can’t count the number of times I have sat and schooled my doctors in how to specifically write my prescriptions so I will be able to afford them.

Repeat after me, “Drug X, 90day supply refillable for 12 months.”

Yes, I now sit down and get those details out of the way, and it’s just accepted like it’s okay for the insurers to decide what and how my doctors prescribe.

It’s not like my doctors went through years of schooling, mounting debt, and tireless hours to be able to possibly cure me.

By the time they’re settled into working it’s a shocker when suddenly the insurers come knocking, saying, everything you learned in all those pharmacology classes is useless since the patient can only afford what we say she can.

Docs might as well just hand the insurers a stamp signature.

Anyway, this isn’t even the point. These are old ramblings.

This isn’t even what sent me over the edge.

I learned something new today.

Thank Adam (I won’t publish your last name) for letting me know about this new special thing called a “floor limit.”

A floor limit is a maximum amount, in Medco’s case $100, that is allowable for billing.

If the bill comes to something larger then you have to put money down on your credit card.

I spent $187.99 for 3 months worth of 4 meds.

I take far more than four.

We’re not even going to get into how EXPENSIVE this today.

I only ordered four, but when I said my favorite words that have worked so many times to get me by before (That’s “Just bill it, please) they hit me with this floor limit.

Obviously, medco has caught on to the lines of broke patients like me and decided they are not fronting their meds anymore.

They will get paid or I will get nothing.

They’re kind of like a big, nasty threatening drug dealer hollering, “Give me my money upfront or you ain’t getting’ nothin’”

In that case I would because I am addicted.

But I’m not addicted, I’m sick, maybe dying, and they still want to fight about getting their money.

So it’s on!

I was told to appeal I “could call management,” but basically, it’s just to double check the policy and they’ll tell me no.

These policies are all very special.

A policy was how I got ousted from getting a monthly income from Reliance Standard.

I bet that case worker got a raise for finding a way to save them $566 a month FOREVER, seeing as that’s how long I will be disabled.

So I did whip out my credit card to pay.

It’s a pay or die option, or if not pay or die, pay or suffer A LOT.

And you were worried the government was going to get in the middle of you and your doctor.

I think money has all ready found its way in between me and my medical care.


Anonymous said...

hey girl, same boat, same shit head company, I feel your pain....

Anonymous said...

you are at your most glorious when you analyze this horrifying situation from within and without (anecdotally and then through the wider lens). i'm proud to read this. thanks for continuing to teach.