Which would be more cruel?
Finding out your heartburn medicine is no longer covered by your health insurance (thus creating an onslaught of gastric acid), or your blood pressure medication has been dropped from the official formulary (and you can guess the appropriate reaction.)
I have neither ailment.
However, either could develop over the saga of dealing with United Healthcare’s prescription drug plan, which has decided to drop coverage of Nexium last month with little fanfare.
I found out about that when I went on line to re-fill my prescription electronically, and was met with an ominous message:
“Effective September 1, 2006, Nexium (esomeprazole magnesium) may cost you more or may no longer be covered under your pharmacy benefit. Before you fill your next prescription, click on ‘Price a medication’ in the left hand navigation on 365wellst.com to check the pricing of your medication or use Savings Advisor to identify lower cost alternatives.”
For those of you who have been through the ordeal of treating reflux or indigestion, you know that not all “alternatives” are realistic. Just as each of us have unique chemical characteristics, so do these medications.
They don’t all work on everyone in the same way.
I called up 365 Well Street, and “Shamiqua” told me that she couldn’t tell me why they stopped covering Nexium on my plan, because I’d been sent a letter explaining it.
That makes total sense.
You can’t tell me the answer to my question because you sent me a letter?
Shamiqua was able to give me the names of five other medications, almost as colorful as her name: Omeprazole, Acifex, Protonix, Prevacid, and Zagaret. She said it was most likely that coverage for Nexium was dropped because it was now available over the counter.
No, it’s not.
According to the CVS pharmacy I checked with, you still have to have a prescription for Nexium.
Shamiqua said, well, I’d just have to talk to United Healthcare.
Undeterred, I called United Healthcare for answers.
My first try resulted in being routed back to Shamiqua's department via electronic phone mail hell, although I didn't wait around to speak to her or one of her sistahs.
(Who ever invented automated phone systems should be shot. United Healthcare’s phone system either offers useless choices, or hangs up on you. The ordeal is guaranteed to produce symptoms worthy of treatment with other prescription drugs.)
So I called the local Houston United Healthcare office. My thinking was, a real, human on the phone could answer my questions, or at least direct me to a better source.
The woman was nice, but clueless.
She routed me to United Healthcare’s HR department, with an electronic phone prompt which refused to budge until I gave them an employee number. Not having such, I outwitted the phone system by outwaiting it, and was routed to another live person…who gave me the number to United Healthcare’s corporate offices (which was not available on their website, by the way; I'd checked that first.)
I dialed Corporate’s toll-free number, and told the real, live operator I needed to speak with the person who makes the decisions on which drugs are covered and which are not covered by their prescription plan.
“You need Formulary,” she said, and rang me through to—you guessed it—another voice mail.
Are you keeping up? Three different calls to three different numbers, so far.
The voice mail identified it’s owner as Joe Stahl, who was out, but would return my call shortly, if only I would leave my name and number.
So I called back later in the day.
Joe has an assistant, Nicole, who’s voice mail also kicked in to capture my message in crisp, digital sound.
She’d call me back.
Last night I received an e-mail from United Healthcare, with the same nebulous, benumbed response I’d gotten during the day, telling me that I could “purchase this medication locally at 100% of the price off-plan.”
Duh. Ya’ think?
The only think more troubling than the insipid, bureaucratic mindlessness these companies exhibit is the insulting, condescending tone they take with their customers.
Here’s the deal.
United Healthcare is in business to make money, not provide you with quality healthcare. That they do most of the time is incidental; don’t be fooled. They’re in business to make money.
Through the process of elimination, United Healthcare has decided that the best medications to take are those that cost the least, not necessarily those compounds which might work the best.
That’s why instead of Nexium, I can either buy something over the counter, or ask for a prescription for something that sounds like you could name your next child.
Too bad the bean counters at the insurance companies know better how to treat me than my doctor. All that education in medical school must have been just a waste of time and money.
If you want to practice medicine, just become an accountant for a health care provider.