Since October, CB has been on a steroid for her lungs that she takes through a nebulizer every night. It's supposed to strengthen her lungs so that when she gets a cold she doesn't immediately end up in the hospital again with low oxygen. She'll take it through the winter and cold season, and then hopefully she'll at least be able to be off it for the spring and summer.
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| Having a breathing treatment with Dad and Daniel Tiger. |
The medicine she has to take isn't cheap. That's okay - she's worth it, and we want to do what's best for her. We're grateful that we started saving money when we did so that her medical expenses haven't been huge burdens. They're mostly just frustrating. Our insurance doesn't cover much of them, and it seems like every time we turn around they cost more.
The other night we went to pick up her prescription, which we'd just had transferred to a pharmacy down here now that we've moved. As I was giving the technician my insurance information, she told me that the insurance wouldn't cover the medicine until Feb. 6th. I asked why, because she had a 30 day supply that we picked up on Dec. 26th, and she only had one night's worth left. She said our other pharmacy had been charging us for a 55 day supply, so we weren't supposed to be out yet. After several more trips to the counter, we finally left without the medicine but with a plan to call and talk to our pharmacy in Centerville.
The next day we talked to the pharmacy, and they told us that no, it just costs that much. No explanation about why the insurance wasn't covering anything. but it was really just twice as expensive as we thought it was. Eric looked online for coupons and found one, then called about 5 pharmacies asking about prices. CVS said they had it for almost half what we were paying for it, so Eric drove down to Provo to buy it there.
And of course when he got there, it was the same price that it was everywhere else.
I just feel like we are constantly dealing with this. No matter what happens, we end up spending hours on the phone trying not to get cheated by the provider or the insurance company. No one seems to know what's going on, so we end up calling back and forth and spending hours talking to these people, and then it doesn't matter. We're really trying to be thoughtful consumers who ask questions and try to pay attention, but it seems like no matter what we do, we don't get the benefits we're paying for or the discounts we've been promised.
A couple of months ago we got CB's ambulance bill for her hospital trip. The bill was for nearly $2000. The price of an ambulance trip is actually set by the state legislature, so although I think that's an insane price for a half hour ride in an ambulance, especially when I pay taxes for things like ambulances, I'm not sure what they can do about it. However. Our insurance claimed that it covered 70% of ambulance bills, so we were expecting a little help there.
Then they told us they were paying about $450 of the bill. It's been awhile since I've had to do a lot of math, but I'm pretty sure that's not 70%.
Both Eric and I spent hours talking on the phone to different people. We were finally told that the insurance company just things that the price the ambulance charges is too much so they set an amount that they think is what it should cost and pay 70% of that. That amount was something like $570.
Don't get me wrong - that's closer to what I think it should cost too. But $570 is nowhere close to the $1700 price tag that actually came with that ambulance ride, and the ambulance company wasn't going to accept that. They said they would appeal for us. They got nothing.
Apparently we were also "out of network" in our "choice" of ambulance. But the closest "in network" ambulance was about 40 miles away. So yes, I'm definitely going to take the time to research that next time and wait the extra 45 minutes while my baby can't breathe and needs to go to the hospital. (Hopefully you can hear the dripping sarcasm and contempt here.)
The thing about it is, I feel frustrated by the fact that this wasn't even an instance where I had a choice, and they are apparently penalizing me for it. I was told CB needed to take an ambulance, and the ambulance was called for me. Obviously I would do it all again if I needed to. But I hate, hate that the insurance company who gets my money every month then gets to turn around and say, "Well, you should have used a different ambulance service I guess, because then we could make them take what we offered." And my only recourse is to send ANOTHER appeal, which will probably also be ignored. And let's not even talk about the hospital bill that was supposed to go around the insurance so we could get a significant discount, then was put through the insurance anyway, but was also more than twice the estimate they gave us at the hospital.
It just seems like it happens every single time we pay any medical bill. I don't know how we could be doing things better except to have better insurance, but I feel like we are trying to ask all of the right questions and figure out how we can make good decisions and pay our bills like responsible people, and it never matters, because everything is so entrenched in bureaucracy and ignorance and stupid deals between providers and insurance companies that mean no one ever has any idea what anything costs. I feel so defeated by the system, and I don't know how to change it. I'm currently researching birthing centers for the next time we have a baby, because I would really just love to be able to avoid the entire mess next time, and birthing centers give you price lists on their websites, which is so refreshing. Of course, I'll probably end up having some kind of emergency and ending up in the hospital anyway, and then I'll have to pay one more bill.
Sigh.
