At some point in time your doctor is going to write a prescription for a medication that is not covered by your insurance. Most likely this will be as the doctor’s office is closing. So by the time you find out...it will be too late. Don’t let that happen. Use this article to prepare yourself. Most likely, you won’t even ask what is being prescribed, won’t see the prescription, and it will be sent electronically, directly to your pharmacy. When you arrive at the pharmacy, you find out that this prescription is not covered by your insurance. You will call the insurance to confirm, and...they will. You might try to call your call doctor's office, but they won't be open anymore. You will be stuck with your child’s life hanging by a thread (not really) in one hand, and a wad of money in the other. Which will you choose?
So that is what happened to us. Our oldest son had the flu. We were one of the last people seen that night before they closed. The doctor prescribe Tamiflu. I went to the pharmacy (the 24 hour one, on the other side of town) and then found out that it wasn’t covered by our insurance. It was going to cost $300. And that was just one of the medications. There were two more that were covered. We had been hearing really bad things about kids getting the flu. We felt like horrible parents for even considering not filling the prescription. But we could have waited just 12 hours to call the doctor the next morning to confirm that there were no alternatives, or fill the prescription that night and get my kid on the road to recovery. I went ahead and called my insurance to confirm that it was no mistake. They did confirm that they don't cover that particular medication. There were no generics to substitute. I begged the pharmacist for some kind of a discount program, so they give me $30 off my $300 prescription.
I asked the pharmacist how most people paid for this medicine. She said that most people's insurance will cover this. I said, “What about poor people? How do they pay for this medicine?” She said that even Medicaid and Medicare actually cover this prescription. But MY insurance doesn't cover this, and I have to pay for it out-of-pocket.
After two hours at the pharmacy, I came home with all the medicine, prepared it (as well as the food to be eaten before my son took it). I went back to where my son was sleeping (at this point it was 10 o'clock at night). I woke him up to take his food and medicine, but he just wanted to go back to sleep and take it the next morning. AHHH! By the next morning I would have been able to call the doctor to confirm this prescription was in fact required, and maybe have gotten an alternative prescribed! But it was too late for that. So he was going to take this medicine, damn it! I made him take his regiment of various medications and sent him back to bed.
As a preventive measure, the doctor actually wrote prescriptions for everyone in the family for this stuff. But since none of the rest of us were not symptomatic, I did not get those prescriptions filled. I will be calling the doctor’s office tomorrow morning to confirm that this is the only available option. Hopefully they can provide prescriptions written for something else that IS covered. At the end of the day, if there is no alternative, we will probably wait until we become symptomatic before I fill those prescriptions at $300 per person.
The prescription insurance representative did say that I could appeal, but I don't know how far I will get with that.
So, my recommendation is that before you leave the doctor's office with a prescription or have a prescription called in by the doctor, confirm it is covered by your prescription insurance or ask for the generic or alternatives. Put a sticky note reminder on your health insurance card right now to remind you.
The List
Ensure prescriptions are covered before you leave the doctor’s office
Location: Doctor’s Office
When: When prescription is written
What: Confirm prescription is covered. If not, ask if there are generics, or alternatives.
