Indulge me for a moment in a little TMI and a very long tale of woe.
The rules that health insurance apply to birth control are complete and utter bullshit.
Now I know coverage varies between insurance companies and the organizations that supply them to employees. I also know I’m very lucky to have insurance at a relatively affordable rate that covers most anything I need to be healthy and well-cared for. So now that we got that nicety out of the way, allow me to reiterate: THE RULES THAT HEALTH INSURANCE COMPANIES APPLY TO BIRTH CONTROL ARE COMPLETE AND UTTER BULLSHIT.
Do you want to know how ridiculous this gets? Three weeks ago I went to go pick up my birth control pill, a task I need to fulfill monthly–
TANGENT ONE – First of all, even though my doctor is more than happy to write out a prescription that allows me to pick up pills in packs of three months at a time, my insurance company does not allow that. I can’t even begin to imagine the reasoning behind this. Does the insurance company want me to think long and hard every month while I’m waiting in line at the pharmacy: “Do I really need these sin pills!? NO! I’m going to change my sinning sinful lusting awful sinning ways and become a nun!”? I’m paying the same amount for the same number of pills, the insurance has to pay out claims and do addition and subtraction and paperwork bullshit 3x as much but No. I am not allowed to get my pills three months at a time. BECAUSE THEY SAID SO.
So my monthly prescription is on auto-refill meaning I don’t do anything except show up. And the pharmacist fiddles through all the orders and can’t find it. Well turns out they are out of that particular brand and I was directed to come back the next day after the order came in.
TANGENT TWO: I do prescribe to a particular brand because every other kind I’ve tried, including generic, literally made me want to kill myself. I was miserable. The point is, in 2010 my insurance company decided that they would NO LONGER COVER this brand as a priority drug which means that my price jumped from something around $20 a month to a whopping $50+ a month. DIAF, insurance company.
(TANGENT 2.1: So when I complained to my doctor about the cost she gave me some sort of prescription discount card from the pharmaceutical company that worked for about three months before it expired suddenly. So my pharmacist recommend I get another one from the company’s website and even though now Pfizer or some other terrible corporation now has ALL of my information, my prescription is back down to a reasonable $25/month)
Day Two at the pharmacy: They have the drug, but they won’t give it to me. They claim that I picked it up the week before which I did not.
TANGENT THREE: Here is where this whole ordeal really starts to annoy me. My insurance will not let me pick up my insurance earlier than three weeks from the date of last pick-up. Because I might be running some sort of birth control ring where I’m constantly supplying it to peopled hooked to birth control? And then every two weeks I go back for a new prescription to sell to more BC addicts? Right.
So because I “already picked it up” (which I did not) the pharmacist says he can’t give me a new one for another two weeks but advises I come back in a week to see if the insurance will release it. Wait what?!
TANGENT FOUR: Normally just picking up this next set of pills would be fine…except my prescription is only twelve months long. I get exactly twelve packs of pills and then I have to go back to the doctor to get another prescription. I have no problem with the fact that the doctor wants to see me yearly before prescribing me something. But my insurance company doesn’t give a shit about anything because I am not allowed to see my doctor again before 365 days have passed since my last check-up with my doctor. I have literally been sent home from the doctor saying to come back on that specific date. I must’ve been too healthy.
I have some back-ups but by the time I return a week later and I’m getting really low. Pharmacist advises that they can’t release the prescription for another week. Would you believe it took this much time and this many trips before I finally complained? Yeah I know, I’m sucker. The pharmacist refused to help me even though they are the ones who either fucked up and gave the prescription to someone else, or whatever it was they did. I didn’t just wander into the pharmacy, pay money, go out and dump the pills in the trashbin outside of CVS! The pharmacist said they can’t do anything and that I have to call my insurance company.
On the phone my insurance company was (surprisingly) happy to reverse the claim so that I could get my birth control sooner but advised they can’t do anything without the pharmacy’s permission. Offffff course they can’t.
So I go back into the pharmacy and demand they call my insurance company. And I sat there FOR AN HOUR while they worked that out. I hear the words HIPAA and compliance thrown around a lot. Finally they settle on their stories: I never came in for the birth control so the pharmacy marked it as never picked up but the insurance company didn’t reverse the claim on their end. Sure, let’s go with that.
In the end, I wasted close to three hours of my life on this whole ordeal, most of it cutting directly into work time, because [a] I can’t compress the obtaining of birth control pills into a 4x a year task; [b] my insurance company won’t just let me pick up pills whenever *I* say that I need them even though [c] that wouldn’t matter anyway because once I run out I’m not allowed to see my doctor until they say so. Great job, guys. You have really managed to save us all from ourselves. We’re all leading richer fuller lives because of this process. Hooray America!
Oh, and I was charged fifty bucks for it. I didn’t even have the heart to argue about it.
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Everything you’ve described shows how backwards healthcare is. But most of it becomes clear if you think about profit and the throttling of consumer choice.
Tangent 1: 1 month of pills costs less than 3.
Tangent 2: brand X is cheaper than brand Y.
Tangent 3: The prescription you fill is subsidized by the insurance company, so they lose more money if you fill more than you’re “supposed to”. The hidden good news: if everyone is having as much trouble getting pills as you, you could turn them around on the black market for a profit yourself!
Tangent 4. Again, you seeing your doctor costs the insurance company more money. They don’t want to pay more than they have to, especially for a healthy visit.
You should switch health insurance companies, but we already know you’re probably tied to one through your job. Hooray for (the lack of) competition and not having health insurance when you actually need it!
Asking your job if they will instead of paying for your health insurance, give you that money instead so you can go buy your own would never work since you are young and healthy and don’t cost that much to insure, and are a great member of their pool to bring down the old boys’ premiums. But even if they did, since your work has already struck a deal with your health insurance company for a discount package rate, the money you’d get back is probably less than what a comparable plan on the open market would cost. Even if it wasn’t, the money you’d get back would be taxable while your benefits aren’t, which might even drive you into a higher income bracket meaning you’d get even less money back. Awesome!
Forget the insurance company. Instead of buying into one, pay cash instead directly to your doctor and your pharmacy and cut out the scheming skimming middleman. Except oh wait! Health insurance companies are huge special interest lobby groups who end up setting the price for the pills you need, and non-members don’t get the discount, so you might end up paying even more for them anyway.
This leaves you with a few options.
1) Quit your job altogether, become a professional blogger, and join a union of professional bloggers who have their own health savings pool, and hope they have enough clout and perspiration to outhustle the giant health insurance companies.
2) Become independently wealthy/win the lottery.
3) Move to Canada or the UK and hope they don’t give you a box of condoms instead.
Contraception is small potatoes except in prostitutes, the poor, and the developing world. Just hope you never actually get sick, because then you will know the full wrath that is American healthcare.