1. I was diagnosed at UCLA Medical Center with MS and

2. I had brain surgery to relieve my congenital hydrocephalus, again at UCLA.

The symptoms I had with my MS were thought to be related to my hydrocephalus, but alas, it was indeed an MS diagnosis. Needless to say, being 3,000 miles from home, my mother badgered me into moving back to the great state of Tennessee.

I took a job with a large health care conglomerate in East Tennessee. I should have Cadillac health insurance, right? HA!

My company, which employs over 9k people in the area, has the worst health coverage of any plan I’ve ever had. And to add insult to my injury, until recently we owned a health insurance company!

My plan relies heavily on using only our facilities, which for MS, is not so great. My out of pocket deductibles for going to the university hospital are outrageous, even though the care is superior there.

I work in the marketing department so I was privy to some information about our new drug plan. We opened our own pharmacy which means we get my MS drug for half price under 340b pricing. That’s roughly $720 for a month’s supply. Under our insurance coverage, injectible drugs cost employees $150 a month. And the kicker? The comment was made that it only effected 65 people. I corrected them that it effected 66 people.

My great health care company is short sighted. An MS flare can cost 5k for each flare. Without drugs, MS patients can have multiple flares a year. Now I ask you, what’s more practical in the long run? Lowering the drug cost back to $60 a month like it used to be so that even the $8 an hour employee can afford them thereby reducing flares, which reduces costs and may mean that that employee may delay becoming disabled by years and sucking disability insurance dry, or keeping the drug cost at an outrageous $150 a month, meaning most employees have stopped taking their drugs, raising the incidents of flares and collateral effects? Lost wages, lost work production, lost quality of life?

Oh, and we have NO out of pocket maximum on our plan.

My company, a non-profit pillar of the community, cares only about the bottom line. Which was increased when Humana bought the health insurance arm of our company for $245 million this year.

I could take a job with better benefits at a lower pay scale and come out ahead.

It makes me so angry that I can’t get an actual person on the phone to work this out in real time. So, I still call and wait while keeping records of doing so.

So we did.

Now my twin girls are admittedly shy. They did not talk easily to adults at that age. We took her to my ophthalmologist from when I was a kid and whom I had seen to that day. He found nothing wrong with her vision, but he had a hard time getting her to respond to him. His “diagnosis” was that they simply had not been able to get her to communicate and they simply referred her on the basis of a lack of response.

Thankfully, a year later, the Lion’s Club did another screening. This time they had the folks call from Vanderbilt’s Children’s Eye Clinic, and they explained the problem and the seriousness of it going untreated. They explained the seriousness of losing time treating it, and how it was imperative that it not wait a moment longer than absolutely necessary.

We made an appointment.

The doctor had her prescription figured out within a minute or two. I was amazed. How did she do it so quickly? The doc simply shined a light in her eyes and could tell the approximate prescription from the way the light refracted off the back of her eye.

Excuse me?

I lost nearly a year of time in treating this disease with which time is of the essence. And I lost it because my doc did not know to refract a light off the back of the eye? It makes me angry even as I write this.

We do not see that first doc any more.

Today, after patching and glasses in an unrelenting regimen, she sees quite well. Her vision with corrective lenses is better than they had hoped it would ever be. In fact, she approaches near 20/20 vision. That’s fortunate considering had I not gotten to a better doc, she might today be legally blind in that eye.

I feel so stupid for not even thinking that prescriptions might be priced differently from one place to another. BTW, I used the same insurance at both places! So it has nothing to do switching from Brand to Generic or some other obvious “savings” scheme. It was just changing who my pharmacy was. OH and the grocery store offered FREE 30 day supply of 7 different generics (we use 3) so that is another $50. Doesn’t seem like much until you add it up.

When my son was born, the insurance company required pre-authorization for the delivery hospital visit. My doctor’s office staff asssured me they would “handle” the authorization phone call when I went into labor. After delivery I decided to call the insurance company and double check since the authorization had to be completed within 24 hours of admission and it was the weekend. I am so glad I did! No phone calls had been made and the deadline was near the end. That single phone call saved my family thousands of dollars!