Wednesday, June 9, 2010

The Spoiler

On my first day at college I was herded, along with the other incoming freshmen, into a cavernous lecture hall where we were given the Minnesota Multi-phasic Personality Inventory (MMPI). The MMPI is a battery of 500 true-false statements which rank you on a dozen scales with names like the Hysteria Scale, the Psychopathic Deviate Scale, and the Paranoia Scale. It creates a psychological profile by comparing your responses to national averages.

There were some memorable statements in the MMPI. Things like “At times I feel like smashing things” and  "I have had peculiar and disturbing experiences that most other people have not had" and “I am a secret agent of God”. (Years later I learned that some of the items, like the secret agent one, were used to determine if the overall results were valid. Presumably if you said you were a secret agent of God you were either not taking the test seriously or you were so psychotic that you needed a different test.)

There was one statement on the MMPI that struck me with such force that I remember its exact wording to this day. “Just when I’m finally starting to have a good time, somebody comes along and spoils all my fun.” I circled True. But I never expected that the somebody would turn out to be a something and that the something in question would be my health insurance company.

I recently changed health insurance providers. My old company raised the monthly premium to well over $1000. New York state law requires that all insurance companies doing business in the state must provide individual direct pay policies to residents who do not receive insurance through their employer or other group source. It further prescribes the coverage and prohibits denial for pre-existing conditions. The New York Insurance Commission even publishes a web site which compares the cost of these premiums.

So when I saw that one company offers the same basic package as everyone else for $400 less per month, I jumped on it. As it turns out, the old adage is still true: you get what you pay for. On paper I still have the same coverage as I had with the more expensive plan. It’s the implementation that is killing me. They do this in two ways – referrals and prescriptions.

I developed an eye infection while travelling in Mexico. When I returned, my doctor sent me to an eye doctor to have it treated. But he couldn’t send me to any eye doctor. It had to be a doctor who participated in the plan and not many do. I was referred to a practice located at the extreme eastern reaches of Queens, one hour and 15 minutes by three different subway lines, then a twenty minute walk. Why don’t any eye doctors closer to home participate in the plan? In the words of my own doctor, it’s because my plan “sucks”.

Prescriptions have become a nightmare. The antibiotic eye drops took three weeks to be approved. Rather than risk blindness, I coughed up $118 of my own money to buy them. The situation was worse for my anti-cholesterol drug. I have been taking Crestor for over five years with excellent results but the new insurance company won’t pay for it. They have Prevastat on their formulary list, one of the first ever cholesterol medications. It is so old that if pharmaceuticals were given copyrights instead of patents it would be in the public domain. It also has some nasty side effects. Within days of beginning the Prevastat I became overwhelmed with fatigue. Then the muscle and joint pain began. Four days later I could barely walk. I called my doctor and he told me to stop taking the drug immediately. Apparently it was causing my muscles to disintegrate and the next phase would have been kidney failure. Thank you, insurance company.

I’m feeling much better now and back on Crestor. In fact I’m feeling so well that I am about to walk to the gym and workout for the first time in two weeks. Now that I am finally starting to have a good time again, I wonder who, or what, is lurking out there waiting to spoil all my fun.

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