As I have mentioned, my husband recently changed jobs. With a new job comes new insurance. For most families I am sure that is stressful but for our family it can be traumatic. Years ago when Louie was interviewing for new jobs, I used to beg him to ask what kind of insurance they had prior to even considering taking a second interview. If they didn’t offer a PPO plan, he literally couldn’t take the job. Because Tiara is considered disabled, she is covered by the state under Medical or CCS in Los Angeles County. Through the years I have found that the best formula to obtaining all her tests, medicines and any procedures or surgeries is by paying for a PPO plan in conjunction with the State helping.
The hospitals and doctors first bill our PPO and whatever they don’t pay, the state will pick up the rest of the tab at a reduced rate. Everyone seems happy, including the doctors and I feel as if we are doing our part paying into the system. But without the state paying the remaining bills we would have been homeless before her second birthday. So we are very grateful to the state, even though the system sucks. Her medical bills exceeded 1 million dollars last year and I can’t even imagine how much they have been over the past 13 years.
Prior to 6 years ago, the state used to pick up the co-pays for her medicine too. Wow, that was great, but because of budget cuts and the types of medicines she is on, that ceased years ago. For the last few years our monthly bills for medicine co-pays has been between $500 and 600$ a month , on top of $1700 for our premiums. I know we are not alone in dealing with how crazy the cost of medical insurance is, but for Tiara it is a matter of life and death.
For the past 2 months we had Cobra during the job transition and now for the month of August we have Aetna. I was pretty excited when I picked up her first prescription and the copay was 15$ instead of 60$. I did a little happy dance for our pharmacist and was over the moon, thrilled. I called Lou, and was explaining how much money we were going to save every month. But then I should have known it was too good to be true. Last week when I brought in a prescription for a new seizure medicine that was just FDA approved, and her doctor wanted Tiara to try, they said we needed a prior authorization.. What? We have PPO and I have a prescription right here.
My pharmacist who is named Young, sees my face at least 2 times a week. When I walk into his store, he always helps me right away even if there are other people waiting. I guess this is probably because we spend thousands of dollars a month with him. So when he told me about the problem, I was baffled. OK well just deal with it and let me know when they approve it. Then on Monday I went to pick up one of her regular meds, she has been taking for over 2 years and he said the same problem occurred. What the F—? “I only have 4 pills left, I will be out before tomorrow night!” She can’t miss a dose and you know this won’t be resolved within minutes.
I asked him for extra pills so I wouldn’t have to start panicking on the spot and of course he complied. Right there is the reason I have gone to him for 10 years. He is the best pharmacist in the world and one of the most important people in our lives. If someone hasn’t done the paperwork, or an approval hasn’t come through Tiara’s life could be at risk, but with the help of my trusty pharmacist we have never had to experience this problem.
Yet, as I am writing this I have made 3 calls to UCLA, sent an email, been to see Young twice and called him several more times, but I still don’t have her medicine. And so I ask again, why is it always so hard? So my advice to you is, if you, or a loved one has medical issues, find a small local pharmacist and build a relationship with that person. It is so worth it even if they aren’t open 24 hours a day, the inconvenient hours are nothing compared to not being able to get the medicine you need.