Friday, January 9, 2004
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Friday, January 9, 2004 |
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Insurance will make you sick By Rick Ryckeley Don’t mean to climb up on my soapbox so early in the New Year, but somebody has to stand up here and shout about the injustice going on in the world to the little people. I’m proud to be one of the little people, and “I can only stands so much then I can’t stands no more!” What’s got my feathers ruffled? What’s got me pulling out my hair now? I can answer that question in one word: medical insurance. Well, okay, that’s two words, but you understand: it’s downright frustrating. Took The Boy to the doctor the other day ‘cause he was sick, and no, I wasn’t cooking again. After the exam, the doctor gave us a prescription for three medications that would help to make him well. Simple enough, right? The Boy and I dropped off the prescriptions at the drug store, and later, after getting The Boy to bed, I went back out to pick them up. Simple enough, right? The pharmacy counter is where it got interesting. Most people have an HMO (Hand Money Over) with some kind of prescription co-pay. The three options are generic, non-formulated and formulated. Generic means, “This drug is not really what the doctor prescribed, and it doesn’t work as well as the real thing, but the pharmacy has plenty of it.” Co-pay for a generic drug is only $10. Formulary means ... well, I don’t really know what it means. I’ve never seen a formulated drug. But if I did it, would have a co-pay of $25. Non-formulated means, “This is the good stuff — the stuff your doctor wants you to have to get you well the fastest. You’re gonna pay through the nose for it.” Co-pay for a non-formulated drug is $50. Confused? Read on; it only gets better. The rest of the people have what’s called a PPO (Please Pay Over) with a prescription co-pay of another kind. The three options with a PPO are generic, preferred, and non-preferred. As with a HMO, the generic drug with a PPO is the same: “This drug is not really what the doctor prescribed, and it doesn’t work as well as the real thing, but the pharmacy has plenty of it.” The co-pay is again $10. A preferred drug is “the one the insurance company, but not necessarily the doctor, prefers you to have,” and its cost is $25. The last choice is the non-preferred one. This is the one yours truly got stuck with. The non-preferred option means, “Whatever you do, you don’t want this plan. If you choose it, you will have to pay and pay and pay.” Yep, that’s what the three prescriptions for The Boy fell under — non-preferred. It was easy to understand when the nice man in the white lab coat explained it to me. He was an expert at insurance speak. “Sir, you must pay 20 percent with a $35 minimum up to $75 on each drug. You must also stand on your left foot and rub your head with your right hand at the same time reaching for your wallet with your left so you can pay and pay and pay.” I paid the nice man in the white lab coat and returned with the high-priced non-preferred drugs and gave them to The Boy. I told him he needed to feel better soon so he could get back in school and finish. hen he could go to college, graduate, get a high-paying job and start paying for my medical insurance and prescription drug benefits. He just looked at me, moaned, rolled over, and put the pillow over his head. “Dad, I’m sick. Go away. I can’t pay for anything; I don’t make enough money.” I patted him on his back and said, “Son, I know just how you feel,” then I turned out the light and closed his door. Walking away from his room, I wondered if I can tell all those people who want me to pay for their prescription drugs that I too am sick and can’t pay for anything else — that I, too, don’t make enough money. [Rick Ryckeley is employed by the Fayette County Department of Fire and Emergency Services. He can be reached at saferick@bellsouth.net.]
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