It's been a little over a week since my "rooftop" experience (sorry, no mountains around these parts) and I keep learning things every day. Something I learned a long time ago is that regardless of what any of us think, in our world, money is what makes the world go around. As terrible as it is to admit, we all know it's true.
I was really excited when I started my current job with Stewart again. I knew I would eventually have benefits and all the trappings that come with a corporate job. Once I actually received those benefits - after the 90 day waiting period - I was a little suprised at how much I would actually pay for them. But, I had insurance afterall, so it's all okay, right? It got even better when I considered seeing a psychiatrist and realized that such visits and medication were covered under my plan. Excellent news, right?
Last week, after my visit with the nurse, I discovered after leaving the office that I didn't have the prescription that I had actually come for. I called the office back, talked to the nurse and had her call it in. Over the next several days, I called the pharmacy to check on the prescription only to find out that it was on hold, needing additional approval from the doctor. "That's weird," I thought. I spoke to the nurse again and she assured me that she would take care of it.
After several days of a lot of back-and-forth with the insurance company, the word finally came that the prescription that I had been given for Zoloft was not covered under my plan. Apparently they covered other similar drugs, Celexa in this case, but not Zoloft. Supposedly a generic form of the drug will be available at the end of the month and it might be covered at that point in time. Yeah, well...we'll see. In the mean time, the nurse suggested trying the "other" drug until we could determine if the generic for Zoloft would be available.
I knew going in that finding the right drug would be a matter of trial and error. One drug that worked for one person might not work as well for me or visa versa. (My makeup is a little weird anyway. It seems that nothing works for me the same as it might for anyone else.) Up until now, I've been blessed my entire life to have been healthy. I've never had a prescription for anything other than an acne cream or something I was given to counter pneumonia or an infection in my body. I've only taken Celexa for 4 days and I'm not sure how it's affecting me. One day I was so groggy, it felt like being drunk. Today, it was probably the best I've felt since I started taking the drug. I know it's going to take some time to evaluate and see what is going to work best.
I've heard stories about how prescription drug companies jockey for position with local doctors' offices. It took seeing the whole thing in motion to realize what I had heard was actually true. I didn't know going in that my insurance company had only 3 name-brand drugs that would be covered under my plan. I should have known this. It seemed ridiculous however that with all the mental health drugs available on the market, my insurance company would only cover 3 of them. I wouldn't be suprised if this were the same with every other insurance provider.
The truth is that this drug or that is preferred or more readily available because of how the drug maker lobbied with this or that practice or insurance group to get their support to prescribe the medication. Go to another physician or insurance plan and it might be something else. I'm not saying that this is bad, but I don't know that it's good either. Supposedly our medical system is much better than in countries where the care is state-supported. Still, in an industry that is supposed to be about valuing life and making it better, it still comes down to good 'ol politics. I can only imagine how the scale expands when moving from the local practice to the large medical groups and insurance companies around the country. Special favors and all kinds of little perks along the way. Recently there were several reports about lawmakers in Washington receiving thousands of dollars in trips and cash. I'm sure medical insurance companies were right there in the thick of it.
What does that mean for me, the patient? Well, hopefully that I can get whatever I need and be better for it. More importantly, I'd better go in with both eyes wide-open, do my homework and pay attention to details - now, moreso than ever. As much as we hope that the doc we see is going to help us or that our insurance is going to pay their percentage of our bill, in the end it's a muli-billion dollar enterprise and they, like any other company, want to make as much money as they can along the way.
Because, in the end, it's about the almighty dollar.
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