Thursday, January 26, 2006
I don't make the rules
"Your total is $40.47"
"My co-pay is always $15.00"
"Yes, madam, I believe you have to meet a deductible at the beginning of each year before your co-pay kicks in."
"But, I have never had a deductible before." She looks at me with suspicion.
"My partner is also on this insurance plan. They changed things at the beginning of this year."
"We did not have to meet a deductible last year."
"I can call your insurance company and ask them why you have to pay $40 instead of $15."
"Please do that" she says in an accusatory tone.
I call her insurance company. They tell me what I told her. They have changed the plan and each member of the family must now meet a $50 deductible before getting the flat co-pay. I get off the phone and relay the information.
"Well, we did get a bunch of papers from the insurance company and I never read them."
I struggle not to roll my eyes.
"Every family member has a $50 deductible? We went to CVS for some medication for my son this weekend and it was only $6.00."
"Well, there are two possible reasons for that. Children may be except from the deductible. By the way, what was the medication?"
"We got a few suppositories for his upset stomach."
"The second possibility is that you had to pay for the medication and that will be applied to his deductible. That is not expensive medication"
"Okay." she said with doubt in her expression.
Why are you here in my store if you think I am trying to cheat you? I really want your business, but you need to understand how this pharmacy insurance thing works. I am very familiar with this plan and well as several others as it is part of my job.
Prescription insurance works like this. You or you employer pays a premium divided up monthly. The premium is your contribution to the plan's payment fund. I pay $155.00 a month or about $1,900 a year for my premium for my whole health insurance policy. Most plans also have a deductible or a part that you must pay before the insurance helps pay. K and I have an individual health policy. Our deductible for prescriptions is $5,000 each. Our deductible for medical care is also $5,000 each. After we pay $5,000 of our prescriptions or medical care, everything is cover 100%. Our premium is pretty reasonable, but the trade off is the very high deductible. This is the only way I can keep us covered right now. The premiums, deductibles, and products and services covered are usually up for review each year. Deductibles have been very common for physicians visits and hospitalizations. Now, they are becoming very common in pharmacy benefits as insurance companies' profits are decreasing with the rising cost of health care.
I don't make up these policies. In fact, I don't even make up the price you paid for the medication. If you were a cash paying customer, I would have asked $51.65 for the medication. Your insurance company said that I can only charge you $40.47 which just covers the medication, the label, and my overhead. Notice, I didn't mention my professional services including the time I took to call your insurance company. I knew all of this before I opened my store. I didn't go into this business to become a millionaire (Sorry, J). I love my job, but I hate it when you assume that I am trying to screw you. I especially hate it when you don't read up on your own insurance information. I hate when you don't believe me that you will pay the same at CVS.
Part of me wants to tell you to go back to CVS and maybe you will after our little exchange. I don't mind answering question about the price of your medication, but please treat me with the respect that a professional in my position deserves. Yes, I know your husband is a doctor. I am also a doctor as is my partner. With that said, let's start over.
"Your total is $40.47"
"I sure will be glad when I meet my $50.00 deductible. This should put me pretty close to right?"
"Yes, madam. I hope you feel better after taking your medication."
"Thanks. I am sure I will. I just glad that I am one of the fortunate people in this country that has health insurance. See you later."
See. I still got the same amount for your prescription and a warm fuzzy from your grateful attitude.
"My co-pay is always $15.00"
"Yes, madam, I believe you have to meet a deductible at the beginning of each year before your co-pay kicks in."
"But, I have never had a deductible before." She looks at me with suspicion.
"My partner is also on this insurance plan. They changed things at the beginning of this year."
"We did not have to meet a deductible last year."
"I can call your insurance company and ask them why you have to pay $40 instead of $15."
"Please do that" she says in an accusatory tone.
I call her insurance company. They tell me what I told her. They have changed the plan and each member of the family must now meet a $50 deductible before getting the flat co-pay. I get off the phone and relay the information.
"Well, we did get a bunch of papers from the insurance company and I never read them."
I struggle not to roll my eyes.
"Every family member has a $50 deductible? We went to CVS for some medication for my son this weekend and it was only $6.00."
"Well, there are two possible reasons for that. Children may be except from the deductible. By the way, what was the medication?"
"We got a few suppositories for his upset stomach."
"The second possibility is that you had to pay for the medication and that will be applied to his deductible. That is not expensive medication"
"Okay." she said with doubt in her expression.
Why are you here in my store if you think I am trying to cheat you? I really want your business, but you need to understand how this pharmacy insurance thing works. I am very familiar with this plan and well as several others as it is part of my job.
Prescription insurance works like this. You or you employer pays a premium divided up monthly. The premium is your contribution to the plan's payment fund. I pay $155.00 a month or about $1,900 a year for my premium for my whole health insurance policy. Most plans also have a deductible or a part that you must pay before the insurance helps pay. K and I have an individual health policy. Our deductible for prescriptions is $5,000 each. Our deductible for medical care is also $5,000 each. After we pay $5,000 of our prescriptions or medical care, everything is cover 100%. Our premium is pretty reasonable, but the trade off is the very high deductible. This is the only way I can keep us covered right now. The premiums, deductibles, and products and services covered are usually up for review each year. Deductibles have been very common for physicians visits and hospitalizations. Now, they are becoming very common in pharmacy benefits as insurance companies' profits are decreasing with the rising cost of health care.
I don't make up these policies. In fact, I don't even make up the price you paid for the medication. If you were a cash paying customer, I would have asked $51.65 for the medication. Your insurance company said that I can only charge you $40.47 which just covers the medication, the label, and my overhead. Notice, I didn't mention my professional services including the time I took to call your insurance company. I knew all of this before I opened my store. I didn't go into this business to become a millionaire (Sorry, J). I love my job, but I hate it when you assume that I am trying to screw you. I especially hate it when you don't read up on your own insurance information. I hate when you don't believe me that you will pay the same at CVS.
Part of me wants to tell you to go back to CVS and maybe you will after our little exchange. I don't mind answering question about the price of your medication, but please treat me with the respect that a professional in my position deserves. Yes, I know your husband is a doctor. I am also a doctor as is my partner. With that said, let's start over.
"Your total is $40.47"
"I sure will be glad when I meet my $50.00 deductible. This should put me pretty close to right?"
"Yes, madam. I hope you feel better after taking your medication."
"Thanks. I am sure I will. I just glad that I am one of the fortunate people in this country that has health insurance. See you later."
See. I still got the same amount for your prescription and a warm fuzzy from your grateful attitude.
# posted by Dawn @ 7:55 AM 
