Saturday, October 27, 2007

Thank you Sir! May I have another?

Imagine your doctor writes you a prescription, you bring it to the pharmacist and he has the medicine. But your insurance company wants your doctor to get the medication pre-approved before they will cover it, and that pre-approval is being held up in paperwork somewhere. You’ve used the medication in the past, so you know it will help. In fact you know that without this medication, you will have problems. So you decide to pay for the medication yourself. Your doctor prescribed it, your pharmacist has it, you need it, and you are able and willing to pay for it. Done deal, right?

Not if the State is your insurance company.

Our children are adopted. They came to us from the foster care system. You can listen to our NPR interview on real audio about the program we worked with. In the end, we have four wonderful children to brag about.

As a result of them coming out of the foster care system, each of the children came with “Adoption Support.” In our case, our children receive Title 19 medical assitance, what is more commonly known as Medicaid. This is not the same program as the hotly debated SCHIP program.

Long ago, we decided to put our children on our family insurance plan offered by my employer. We do this for emotional reasons. We don’t want our kids ever believing we wouldn’t pay for their health care, and translating that into some message of rejection.

So Medicaid functions as a secondary insurance policy. Whatever is not paid by our employer provided insurance is then covered by Medicaid. So that $15 dollar doctor visit co-pay is covered, the seven dollar medication co-pay is covered. The glasses that get broken before the two year cycle is up are covered. It’s nice, but it really doesn’t add up to any large sum benefits.

To maintain our eligibility we have to submit annual tax statements and jump through some hoops. Last year they required a second opinion before a medication could be covered, which resulted in a trip to a doctor they selected at Children's Hospital. This year just before school started, the State sent us a letter informing us they wanted all four children to go in for a check-up within 30 days. The doctor’s schedule is pretty tight with all the new kids getting ready for school and athletics, so getting four kids non-emergency medical attention is impossible. We got them in within 45 days, but we had to pull them all from a day of school.

Today I encountered the exact situation described in the opening paragraph, where the doctor prescribed, the pharmacist was able to provide, our primary insurance would pay for most of a medication,
but the State wanted pre-approval to cover only the CO-PAY. I tried to pay, and the pharmacist said he was unable to let me do that. If he were discovered accepting money from someone on Title-19 insurance, he could face penalties.

Gee thanks. I’m glad my government knows so much better how to take care of my family’s health than my doctor and I do. I can’t wait to have more government run health care.
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