Lessons I learned - So You WON'T Have To

I must freely admit, this time I screwed up.  BIG TIME.  I took answers I got at face value, if there were any other pertinent information, the person I was speaking with would tell me.  Or so I assumed.

Part of the problem I am dealing with right now is my own damn fault because I got lazy and did not ask the questions I should have and advocated harder for myself.

It all has to do with Part D of Medicare, the drug part.  You must get a separate insurance policy to cover drugs.  Well, I got a letter that said I qualified for a policy at no cost.  After reading the letter, I am thinking to myself, well, let me make an appointment with the insurance councilor with the Department on Aging and ask a couple questions.  I was going to make sure my drugs were covered.

Four Tablets for breakfast every day.

The appointment day showed up, I go and bring all the papers I got saying the same thing.  I did not have to do anything, I qualified for this drug coverage.  I shared my concern about my drugs being covered.  She looked up the Votrient, Zofran and Compazine.  All were covered.

The relief I felt was palatable.  I felt as if a huge weight was lifted from my shoulders.  I could have danced.  I was so relieved that all the other questions I had intended to ask flew out of my mind.  Hence one of the lessons.

One of my two best friends

I had wrongly assumed if there were a deductible or co pay she would tell me since she was looking at the policy information.  I was wrong.  I should have asked. 

A week ago, Monday, I got a bug in my head and called the insurance company since I finally got the insurance card with policy number and contact information. 

I knew I was in trouble when I got a busy call center.  There was all kinds of background noise, and the line kept cutting out.

She kept trying to give me information I was not asking for.  I finally told her to stop.  I wanted to know if my prescription drugs and chemo drug were covered.  Please answer the questions as I ask them.

Votrient, yes.  Zofran – only the generic, but it must be preauthorized. 

My second best friend.

Anti-nausea medication, the generic form needs preauthorized.  So, I get the phone number the doctor is going to have to call to get it done.  (The chemo drug does not need preauthorized).  Compozine, generic covered, no preauthorization.

Now I ask, are there co pays?  She says, yes, but the co pay kicks in after the deductible was met.  Me: “Deductible?  What deductible?”  Who ever heard of a deductible on a drug plan? 

Her reply “$415.00.  I sigh then ask ok, what are the co pays after the deductible is met.  (I am thinking, ok I can meet that with a couple of the Zofran prescriptions, that stuff is not cheap.)

She starts with the co-pay amounts, since the Zofran is tier 2, $3.00, the Compazine is tier 2 so $3.00.  I am thinking so far so good.  Then she says the Votrient (my chemotherapy drug) is tier 5, so it is 25 (at this point I was thinking $25.00 during her pause.  I could live with that) then she says percent.  I choke.  I repeated back 25%??  That is $3250.00!!!  And only if the pharmacy you work with charges the same amount as the one, I am dealing with now.  The cost for this chemo is $13,000.00 a month.  (Trust me it is cheaper than some of the other chemo I have been on over the years).

So right now, I have applied to the manufacture for grant money to help cover the copay on the chemo.  And I am scrambling to find other means to cover by applying to foundations.  One told me they could not help me because they do not have funds to help people with my kind of cancer.  Another said they were a last-ditch foundation, and once I am turned down from the others, they may be able to help.

Now this is what I want you to learn from my mistakes:

1. You are your own advocate.  Do not assume that just because a person deals with things regularly they will give you all the information you need.
2. Sit down before you talk to whoever, and think about the information you need.  Write those questions down.  Bring them with you.  Get others to suggest questions.
3. If they start going down a side topic, bring them back to the question you asked.  And tell them to answer that question first, then the next question.
4. If you do not understand what they are telling you say that.  Just say, wait I do not understand.  Make them explain it to you.
5. There is no such thing as a dumb question (especially when it comes to health care and insurance)
6. This is so important it needs listed twice:  DO NOT ASSUME THAT YOU WILL GET ALL THE INFORMATION YOU NEED EVEN WHEN DEALING WITH “EXPERTS.”  YOU NEED TO ASK QUESTIONS.

Now that I learned to ask more questions, I hope you have too.