Wednesday, April 9, 2014

I've told my son's healthcare story, now here's mine.

I have a kidney disease that I was diagnosed with when I was 17. It has always been easily manageable as all I've had to do is take blood pressure medicine.

But last summer, I got incredibly painful gouty arthritis in my feet and ankles caused by uric acid build up related to my kidney disease. At age 31, you can imagine how badly my ego was bruised when I had to use a cane to walk and was even on crutches for 2 weeks.

I went to see my primary care physician for help ($40 copay). She prescribed the only medication on the market that would lower my uric acid levels and give me back my mobility. I took the prescription to my pharmacy to have it filled and found out that my insurance would not cover it. They suggested another medication (that they also didn't cover) that would cost less but wouldn't even help in my situation (talk about getting between me and my doctor!). To get the drug that would actually help me walk again, the pharmacy told me that I would have to pay out of pocket for it which was $400 per month!

Of course, we couldn't afford that, so with nothing left to do but cry, I left without my medication and made an appointment with my nephrologist ($80 copay) to see if he could help. I went in to see him and, once again, he said that I needed to take that medication that I could not afford. I told him what had happened with my insurance and he rounded up 12 weeks worth of samples of this miracle drug for me.

I cried some more. That would've cost me $1200 at the pharmacy.

Within just a few days, I was able to walk again and I stretched those samples out as long as I could by skipping doses. When I went in for a follow-up, he gave me 8 more weeks of samples to try to help get me by (that's $800 more he saved me).

The icing on this shit-cake? Even though I had notified my insurance company when I bought our plan that I had a kidney disease, these arthritis attacks sent up some kind of red flag with them. They went back through and underwrote all of my visits and labs with my nephrologist and denied all of the claims due to my "pre-existing condition" (even though I'd never had arthritis like this before). In all, I believe that cost us well over $1000—which didn't go toward our deductible.

I signed up for a plan through this year and, thanks to Obamacare, I now have a plan with a $0 copay for primary care, a $50 copay for specialists, and a guarantee that things related to my "pre-existing condition" will be covered. Talk about peace of mind. To be perfectly honest, we bought a much more robust plan and will be paying about twice as much per month for our insurance (we could've paid less for less coverage but I wanted a really solid plan).

I ran out of the samples of my miracle drug 3 weeks ago and my ankles have already started to show signs of a flare up. So when I went to my primary doctor today for a check up, she gave me yet another prescription for this drug that I need to take to be able to walk. I took it to the pharmacy and this time, my copay was $55.


(generic prescriptions are $3 btw in case you were wondering)

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