After several years of joyously passive health care insurance through Microsoft where everything was handled without thought or care, my family and I have been thrust into the world of overly expensive health care that is obstructive, opaque and frustrating.
Microsoft was with Premera Blue Cross. We went with the Premera subsidiary LifeWise of Washington. With a premier plan, not as the Afflac pigeon squawks: only major medical. We expected rational policies and good customer service.
We have experienced neither.
The biggest issue comes in the form of drug prescriptions, some of which treat long-term conditions and have been in our regime for years. After checking what was covered before we signed-up, and then working diligently, sometimes for hours with physicians, we have routine rejections of prescriptions. Nexium for instance, isn’t covered, though it was prescribed to help me with vocal chord issues that could affect my delivery of presentations. Since Nexium, no problem. Since LifeWise, no Nexium.
My wife has other prescriptions, some of which received wavers, one that was dated through 2099, on LifeWise letterhead. It was revoked and not reinstated even after an hour on the phone with various apologetic, but unhelpful members of LifeWise and Medco. She was told they no longer honor their own wavers.
If you are living in this same world, then you are probably not shocked by any of this. If you live in the world of corporate health care, or were recently laid off and still living under the Cobra umbrella, consider this a scenario worth planning for. As soon as you move into the world of private health insurance put your buyer beware sensibility on high and be prepared to invest in defending yourself to a system that is purportedly designed to service customers, but doesn’t seem to be motivated to do so.
To keep things simple, "no" appears to be the best and most consistent answer to most inquires, and when "no" isn’t consistent with the customer’s expectations, alternative ways of saying "no" are invoked, along with forced pathways through circuitous processes that offer frustrations in order, it appears, to eventually drive disengagement.
As we continue to hold a national discussion on the future of health care, it would be of benefit to all if the current providers were rational players concerned with their subscribers. Those who do not have coverage may have one benefit over those that do: time not spent negotiating with a provider (though I sincerely understand that you may have much bigger issues you are dealing with).
I know health care providers are money making businesses, but as a human service business, short-term cost avoidance or cost containment shouldn’t be the primary economic model. When patients have issues that are treatable, they should be treated instead of pushing off those issues into a more costly future. The providers owe it to their shareholders to think long-term.
I have not found my LifeWise experience, as their advertising suggests, boringly good, just boringly frustrating. I hope that they, and all of their competitors start:
- Acting like rational players
- Institute more transparency and disclosure in forms that regular consumers can understand
- Focus on outcomes over efficiency
- Put the patient/paying client, first, always
And recently, we were told that the policy we hold will be discontinued next year. But not to worry now. What do you think? Should I start worrying now?
So sorry to hear you’re having to deal with this. Remember how much we hated HMOs 15 years ago, when every copay was $5?