One would think I should have learned my lessons over the years in maneuvering through the byzantine world of American healthcare delivery (trust me, its not a SYSTEM, folks, but a world where every party involved tries to skim a little extra profit off the ridiculously high premiums Americans already pay), but I routinely find out that's not the case.
Over the years, I have shared stories of how I had like 4 different healthcare plans over the past six years yet have been with my employer for the past fifteen, and it wasn't because I switched plans in open enrollment because the only choice I had was to be covered or not. Each change brought new rules, new formularies and new appeals processes. I switched to United Healthcare a few years ago and compared to Wellpoint/ Anthem, I'd say they've been light years ahead. Its hard to believe, but I've been the proud owner of a Dexcom for almost a year now, something that wouldn't have been a possibility with my old insurance plan. There are things about the Dexcom that drive me crazy, but in the grand scheme of things, its been key to a much better night sleep for me and my spouse. It also helps refine overnight basal dosages and insulin-to-carb ratios, and, the kicker is that there have been no severe hypos while I've been wearing the thing, which alone could be saving the insurance company thousands of dollars (one ambulance call would erase any savings they save by denying me a Dexcom). Why any insurance company would choose to fight this is beyond me, but I've been glad to enjoy it.
Anyway, my stockpile has been running down and I thought I should refill, but I learned firsthand of the profiteering that goes on in the generics business. As I know for a fact, even without insurance, I could get lisinopril for $10 for a 90-day supply just by ordering from CVS Pharmacy, Target pharmacy, Walgreens or Walmart pharmacy. So I wrote to United Healthcare and OptumRx (I addressed my letter to the CEO's office; in my experience, its much faster to go from the top down rather than the bottom up), and said I would transfer the prescription to another pharmacy if they weren't willing or able to match the co-pay amount of $10 (OptumRx charges $25, and supposedly United Healthcare is picking up a portion of the total amount, so the unknowing patient is being screwed deep and hard here) - without having to submit a claim to United Healthcare at all, so why the hell would I agree to pay 150% more for a drug that can be bought without insurance for next to nothing? That makes no sense. I guess that's what is supposed to happen with healthcare insurance, but it seems stupid to me.
I should have known better and just sent it there in the first place! Note to self: make it easier on yourself next time and do it that way, Scott!