More insidious than stealing money, Insurance Companies Steal our Time

Luna practices taking her shoes off before her Synagis injection.

Last week was truly one of the most difficult of my life. Many of you (and I cannot thank enough those who sent emails, tweets and comments of support, you literally carried me through) followed along as I tried in vein to get Luna her last Synagis shot of the season.

The week came to a triumphant end on Friday when I received a phone call from a woman at WellPoint, the parent company of Anthem, and center of loads of negative media attention over the last several weeks; as the CEO was called to testify before congress to defend her nearly 10 million dollar a year salary (a mix of salary and stock options, this number does not include her private jet usage another other perks). WellPoint and subsequently Anthem, earn their profits through the percentage of their earnings that don’t go to healthcare; paying doctors or for medicines and treatments. In other words, it doesn’t take much to connect the dots on why the insurance companies would have virtually no incentive to pay for the costly Synagis treatments. And it is this very jump in profits, during the deepest recession in 80 years, that has caught the eye of Congress.

The WellPoint representative called to say she was following up to my letters I had sent earlier in the week. (I had sent a letter along with my blog posts to both Anthem and Precision RX customer service.)

And apparently I caught the attention of the CEO of Anthem.

But back to WellPoint for a moment. The woman who called was incredibly kind. She said that she was following-up to make sure the Synagis was shipped to Luna’s pediatrician. I told her, "Yes, I had received a phone call from our doctor's this morning confirming delivery".

She went on to say they she was reading my blog, and she and her colleagues at WellPoint, along with her colleagues at Anthem were cheering Luna on.

I was touched. Really. I almost burst out into tears.

But then she went on to say that: lot's of people complain, but I had written in such a compelling way that I wasn't pointing fingers, or ranting, I had told a story about a little girl who was not getting her medicines.

I was honestly moved by our conversation and flattered by her kind words...but I still felt a sour taste bubble-up in the back of my throat. I happen to write for a profession. And I offer social media and publicist services to those in the home and garden industry. And to date I have successfully reversed nearly $8,000 in denied claims through the power of twitter.

But what about those who don't write, tweet and blog for a living? I am, in a sense, an expert complainer. And even I sometimes don't communicate the best I can-simply because I am exhausted in trying to keep up with this thing we’ll simply-call-the-insurance-madness, ON TOP of running my business, along with...you know...that other duty that still no one has given any real value to; that of course being a mother.

So, while I appreciate the kind words, is this really the best we can do?

Perhaps my biggest complaint of all is the time that Anthem steals from me. Last week I put at least 80% of my work time into what many of us call The Synagis Nightmare. Time that is not just taken from me, but since I represent architects, designers and photographers, we can justifiably say that Anthem stole their time as well. And time is money. If I'm not out pitching, writing, blogging and tweeting for my clients; it's only diminishing my efforts to land them more clients.

Since posting on the topic; dozens of mothers and fathers have emailed or stopped me to say their Synagis has been discontinued for their preemie, heart baby, or child with cystic fibrosis.

Which once again begs the question: why do the makers of these powerful and lifesaving drugs bother to tease us? If no one can afford them, and the insurance companies have no incentives at all to pay for them; then what is the point?

And back to Luna's Synagis shot. It dropped from $2791.64 to $1825.13, still no one has been able to tell me why. Just a week ago, before I blogged about the topic, the shot would have cost our family nearly $1000 more.

Synagis Follow-up

Yesterday I posted a blog about, how Luna and I were treated like circus animals (as described brilliantly by one of my friends)-all in our quest to get our two year old a much-needed and time-sensitive shot called Synagis.

Just after I posted my blog about the Synagis/Anthem/Precision RX heist, I sent the post, along with an email to the aforementioned parties.

By 6pm when I heard nothing from any of the three, I have to say, I was feeling flat-out depressed and started contemplating how I could get my family out of this country, and into a more civilized nation; one where healthcare runs smoothly and affordably-and one where half the population isn't crying government takeover (a very clever and carefully crafted message to instill the very outcome it's generated).

Finally, last evening I checked my email around 7:30pm and a rep from Anthem had written to say "thank you for the note" and asked me what state we were in-to which I replied immediately: New Hampshire.

About a half hour ago, Precision RX, the suppliers of Synagis, the shot that Luna is now about 3 weeks over due for; called to follow-up.

This is what the very kind (and really, the reps-all women-are truly nice, it's the system that is maddening) said:

"Renata from the pharmacy solutions department at Anthem called to say that your co-pay for the drug would be $1825.13, and to go ahead and process it immediately".

This new figure of $1825.13 is indeed wonderful news, a vast improvement over the original $2791.64 that was due.

And somehow (as in it took a day of blogging, tweeting, emails and phone calls) everyone is perfectly fine with billing the balance after the $800 down payment into monthly payments of $512.57

I asked the Precision Rep why the co-pay dropped nearly $1000, and she could not answer.


Footnote: I actually had a few angry commentors to my previous post, one in particular called me, "full of crap". I think the most diplomatic rebuttal is to say, I love business, and if you are selling hand bags, furniture, jeans, paper clips and even coffee; by all means, sell for the highest you can!

But when it comes to lifesaving drugs, medicines, and medical treatment for kids (and adults); shouldn't we be a bit more transparent with the cost and yes, fixed with the fees for these services?

The Synagis Scam

Synagis is the brand name for an inoculation that is given to high risk babies and toddlers to stave off RSV. During the RSV season, which is said to run from October to April, our special kids (sometimes referred to as chronic-yuck) are brought into to their pediatrician every 30 days to receive the biggest, sharpest, longest, scariest injection you've ever in your life seen. And I'm not exaggerating here, even the nurses and doctors will admit, it's a beast. So much so, that my 4 year old, who typically joins Luna and me to these nerve racking appointments, has coined the term 'points' for the injection.

Medically-needy kids (another term I loathe, but I don't have the time to invent a new vocabulary...at least right now) are perscribed to receive the shot from birth until they reach 24 months of age. Luna technically has just one more shot to receive, since she will be 2 a week from tomorrow; but since she is going in for her Fontan surgery early this summer, it is advised that she gets the inoculation through the end of the season-which would mean vaccinating her into April).

What is medically advised and what one can afford are two totally different things. A thought, which apparently, none of the drug makers care to consider.

Two weeks ago I started making my regular calls to the two pharmacies we use to order the medicine. Ascend Specialty RX, which is local-ish to us, and located in Portland, Maine is wonderful to deal with. Only problem is they will not accept a payment plan. Period. And I think (need to look further into this) the reason is, their contracts with the Big Insurance Companies don't allow it.

This of course begs the question: why is an insurance company dictating how and when and essentially what kind of treatment we receive? To paraphrase someone's tweet on twitter last week: I think the big disconnect here is that insurance is not healthcare.

After learning Ascend couldn't accommodate a payment schedule, I moved on to Precision RX. They are located in Indiana, and while most of the reps I deal with there are pleasant enough, the company is completely inept.

On February 22nd, after about 2 hours of calls and wait times, I was assured it would be okay to pay an initial payment of $800 with monthly payments of $500 thereafter, for the remaining of the balance. (another tidbit of information here, the total price at Ascend, for the same shot, same exact dosage was $2400. At Precision, once it was determined that we would need a payment plan, that price climbed an additional $392 to $2791.64).

Disgusted, but determined to get Luna inoculated, I gave the rep our HSA account number, she deducted the $800 and the shot was scheduled to be shipped to Luna's pediatrician the following week.

Not so fast.

Yesterday morning I managed to get the girls up and out, so I could drop Sienna at school then race the 30 miles to Luna's doctor to make the 9am appointment.

The two of us tumbled into the office at the stroke of 9, and were immediately ushered into the tiny, dated examining room.

The nurse walked in a few moments later to explain there is no Synagis shot in the fridge.

Reeling, and knowing just what was happening...(I learned last year that if you need to go on a payment plan for these shots you are stonewalled; sure in this country you can finance your house, your car, your mattress, but a medically necessary shot for your child; nope, can't be done).

So I bundled Luna back-up, strapped her into her car seat and called Precision, putting the phone on speaker so I could get a head start the 30 mile drive back to Luna's school.

Finally after about five minutes on hold, then another five while the rep spoke with a supervisor I was told something along these lines: The shot was cancelled, something to do with Anthem not giving the proper referral, yes ma'am we'll look into it...our supervisor is on it...we'll call you later today.

It's now 9:30 the following morning, and I have yet to hear a word