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Non-violence or a posse? I'm worked up, so be forewarned...

Posted Jan 05 2011 12:58pm
Dear Anthem, Yesterday, I called Rite-Aid and asked whether you had decided to approve the Vimpat, a new anti-epileptic drug for my daughter Sophie. Remember us? The folks who pay tens of thousands of dollars a year in co-pays and premiums for your services? You know, the ones who have had their individual rates raised by over 70% in the last few years? You know, the ones who have separate policies for the rest of the family because Sophie isn't insurable with a pre-existing condition? Well, I was relieved when the pharmacist told me yes and literally jumped into my car to go pick up the drug. After all, our neurologist had prescribed it for my daughter's relentless seizures nearly two weeks ago, and when I had a tearful call with the doctor today about how poorly our daughter is doing and how worried we both are about her, well -- I'm anxious to get started with the new drug. I got to the drug store and ran inside. The cashier had to root around for the prescription, but when she found it, she said  Did you know that you have to pay $680 for that? [from here on out, all numbers are estimates because I can't remember the exact amounts -- suffice it to say that they are around the numbers quoted here, except for the deductible, which is EXACT] I said What? She said, There's a $250 deductible and because the drug isn't on the formulary, you have a co-pay of 50%. It's a $800-odd drug -- for a 30-day supply. So, I ran out of the drug store and home to call you.
Yes, indeed, the nice lady told me on the telephone, after I'd waited for fifteen minutes. You, Anthem Blue Cross decide which drugs you will cover and which ones you will not cover, regardless of what a neurologist has ordered for her fifteen year old patient who is suffering from drug-resistant seizures and is currently having 3-5 tonic episodes a day and hundreds of myoclonic ones. The new drug is very new, so new that it might work differently on said child. In fact, it might even stop some of those seizures. But we can't afford a $400 drug each month, especially given the fact that we already pay $250 a month for another drug that is non-FDA approved that we get from Canada. We can barely afford to pay you, after all!

What are you going to do about it?

I'm wondering whether to gather up the usual posse -- volunteers?

Or perhaps I should just park myself outside of the Anthem headquarters and work on some non-violent protest?

You know what? I'd welcome THE GOVERNMENT coming between myself and my insurance company today. Because I'm sick to death of the insurance company coming between me and my doctor. The state of this country's healthcare system is a sham -- and this country should be ashamed of itself. The Health Insurance Reform Act doesn't go far enough. Anyone who doesn't support radical change in our health insurance market should be ashamed, and I'm tired of mincing my words: WE NEED SOCIALIZED MEDICINE in this country, still the richest and most powerful on earth, and EQUALITY. At the very least, we should get what we paid for and help the most vulnerable of our citizens.

So there. And later I'll tell you about the remarkable talk I heard last night from Joseph Goldstein, the Buddhist philosopher. No joke -- I'm all zenned out.
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