A 50+ Healthcare Story in Central Mass.

Just had to share my latest brush with the Healthcare Bureaucracy (HB) that is ours in the Commonwealth of Massachusetts in middle of the second decade of the 21st century. For the past decade I have mostly been self-employed, and providing excellent services to clients rather than providing the same level of excellent, diligent service as an employee. However, that has put me squarely in the category of folks who have “enjoyed” the various incarnations of required purchase of health insurance, originally known as Romneycare and variously later on as ACA/Obamacare. As a fifty-plus individual, I had a fortunately minor health scare back in my thirties. As a consequence, for about 20 years, I have been taking a small dose of a medication that used to be a brand name and is now a generic, mostly produced in India.

Trying to save money and motivate myself to obtain good health care, I have tried various health insurance plans for the self-employed over the past five years or so. Each year, I created spreadsheets to try to figure out the potential costs and compare plans. By far the best year under this regime has been the year that I was self-insured, aka “the year of living dangerously.” Total out of pocket costs for medical care, including prescriptions: under $700, plus the cost of the sports club that I attended regularly and due to which I lost the weight I have been trying to lose for the past five years. Saw a nurse practitioner twice. Skipped the annual appointment with the internist whose main effort was to “fat-shame” me into losing the weight that we both knew I needed to lose. Instead actually focused on my health, my diet and my exercise. Of course, I know that I was extremely lucky not to be injured or to come down with something over the course of the year. Plus the penalties for disengagement with the HB are said to be increasing. As well, I felt (slightly) guilty for being one of “those” healthy adults who did not purchase insurance. So I ended the self-insurance experiment.

Transitioning back into the HB was rather fraught, as I imagined that it would be. Three years ago, I spent over 40 hours of work doing research and being on hold at the Mass. Health Connector and finally ended up with a private company that sells the same plans in 30 min. Last year, after only 20 hours of research, including being in touch with an out of state website (a start-up in California)  that asked ILLEGAL QUESTIONS about medications (ie, “pre-existing conditions”) prior to selling a plan, I ended up back on the Mass. Health Connector, which to its credit, had improved to the point where phone calls are not necessary. (My millennial adult children,.when I mentioned the start up’s questions, said “Mom, the questions are illegal, that doesn’t mean that you have to answer them.” I applaud their infinite patience with our century.)

The plan I ended up with this January was a different insurance provider than I have used previously. I am trying to approach it with an open mind. In checking their website, I found that I had to give up the pharmacy that I have been going to for over five years. So I called the nearest pharmacy affiliated with the health plan and asked them to please transfer the file. Because by the 6th of the month, I had not yet received any material from the new plan, and I did not feel like spending hours on the phone, I decided to pay privately for about a week’s worth to tide me over. Now it seems to me that with my previous provider, I had received my insurance card, etc. by the beginning of the month. We can indulge in Postal Service blame for that particular issue, it is well known that the post is slow in Central Mass.

The new pharmacy asked me to come in at six pm to give them enough time to pick up the prescription, and I said I would come in at 7 to give a little extra time. I missed a phone call from them around seven pm, and went down to the pharmacy, where I was told that yes they had received the file but they did not have the material in stock, and to come back tomorrow after 11 am. The next day, I came back and no, the Rx was not ready, and when I inquired I found that the price per pill was going to be over $2. This was about three times as much as the private price per pill at the previous pharmacy, which had provided a small amount to tide me over at one point. So for a month’s supply of this 40 something year old, generic pill would be over $300. I would estimate that this pill cost no more than five cents to make and ship from India. So some entities are splitting a 40-fold profit. The pharmacist told me that he himself was once out of insurance, and made calls to many pharmacies to obtain the best deal. There I go again, getting ripped off because of being unwilling to spend hours on the phone. Finally, as the last straw prior to going out the door, the pharmacist asked me to confirm the name of the medication, when the next customer had proceeded to the cash and was able to hear clearly, therefore violating HIPAA.

Aside from chuckling,  at my own expense as well as that of the HB, it is not clear whether there are any next steps to take other than perhaps to switch pharmacies again and consider switching insurance again if other aspects of the new plan are equally cumbersome. High drug prices are hardly a new story, and the privacy law for medical records is a joke, because there is complete lack of privacy in the USA. All told, here is my rather safe prediction for the Healthcare Bureaucracy in 2017 and beyond: there is going to be push-back against the current state of affairs.

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