Saving Money

I love saving money.  Don't we all?

Husband takes several medications a month, ad our prescription co-pay is $15 for each generic.  I am sure you can do the math.  While renewing our insurance plan a few weeks ago I noticed that we could mail order for prescription for a 90 day supply at the price of a sixty day supply, or $30.  These seemed like a good plan to me.  So Husband asked his doctor to rewrite a few of his scripts for 90 day supplies.

Just as I was getting ready to mail them off I noticed you could get certain generics medications (some 300 different ones) at the grocery store for $9.99 for a 90 day supply.  Husband checked the list, and sure enough the two we were about to send out to get filled for $60 total, we could get at the grocery.

Nice!!!  So what would have cost us $90 for two, three month supplies ended up costing $19.98.  Which is even far less than the mail order plan.

Now my only concern is that I put too much money into my flexible spending account for the year... but I suppose if it comes down to it we'll just have to have some extra massages and new eyes glasses.

You Suck

That comment would be directed at my new insurance company, United HealthCare Oxford.

I take the mini pill, the recommended oral contraception while breastfeeding.  I take a generic.  Sometimes CVS gives me Heather, sometimes it's called Camila.  Same difference.  Under my old insurance it was a $10 co-pay.  With my new insurance I was expecting a $15 co-pay, as our co-pays went up.

So imagine my suprise when I go to get it and they tell me it's $35.99.

I decline to pick-up my prescription, at the price, figuring there must be some computer error.

I call the pharmacy line, enter my 15 digit member ID number more times than I can count... only to get told it's a Tier 3 drug under our new plan... and I have to meet a $100 deductible, then I can pay a $40 co-pay... or just buy it out of pocket for less.

Seriously.

So they recommend a different brand of the mini-pill (Miconor)... because apparently they know better than my doctor.  Who, by the way, I know need to call and ask for a medication change... because the pharmacy can't make the substitution.  You've got to be kidding me!!!

Note: our Rx's are covered by a 3rd party... who also sucks... but I still blame United for picking these jerks to work with.

Pneumonia

Monkey has been under the weather for some time now.  He's been running a low grade fever in the high 90s low 100s for the better part of the month.  At first I decided he just had a normally high body temp, like his daddy... but now I wonder if I was just being a "bad" mommy.

About this time last week he started getting higher fevers, 101 to the 102 range.  I figured he was just coming down with the bug that all of us had had recently.

Then, at about the same time the lights went out, his fever spiked to 103.8F.  That's Murphy's Law isn't it.

I held off on calling the doctor for a few days, monitoring his fever and increasing his Tylenol/Motrin combo per his "little blue book" from the doctors.  It didn't help that we didn't have phone service at the house, and cell calls were limited to 911.

Finally on Wednesday morning, after listening to him coughing something fierce, I decided enough was enough (and Husband was thrilled, being a first time dad he doesn't like the wait and see approach) and called the pediatricians.

His temp was 103.8 (again) when we got there (after having Tylenol an hour before).  The doctor on call gave me two options 1) wait and see and call back if the fever isn't gone in 2 more days (because fevers can run 3 to 5 days) and 2) get a blood panel done.

I went with option 2, because really who needs to wait two more days, pay another $35 co-pay, and spend another 40 minutes driving there.  Plus, I was ready for answers... his color just didn't look good.

We'll I am glad I went with option 2.  His blood panel came back with mixed results (and he was anemic); so the doctor sent us to the hospital for a chest x-ray to rule out (on in depending on how you want to look at it) pneumonia.

Turkey was so worried about his little brother at the hospital and went to the gift shop with Husband and got him a stuffed doggie while Monkey and I took care of business.  The x-ray confirmed he did have pneumonia.   And he was started on antibiotics.

Shortly after we got home from x-rays.

We had a follow-up with another doctor-on-call on Friday, and when she listened to his lungs she could hear the pneumonia.  She hypothesized that the other doctor-on-call  (Dr. C) didn't hear it the other day because he must have been dehydrated from his high fevers (not to self, do not trust Dr. C, be leery of Dr. M).  But Monkey was certainly on the re-bound and gave him the go-ahead to go to swimming this week, but no going under until he is done with his medication.  Yay!!!

Before swimming this morning, acting and looking more like himself.

I must say, for his first illness Monkey certainly went all out.  Why couldn't we have started with a simple cold or ear infection to break daddy in with?

What I Don't Get

I just don't understand insurance.

I was looking over my "explanation of benefits" for my hospital stay with Monkey, and if I am looking at this right (which I assume I am, as the form seems pretty self explanatory), my insurance company wants me to pay a deductible for an amount more than I was billed.  The insurance company received a bill for $3.4K from the hospital.  But they have a contract rate of $5.5K but will only pay them $1.7K... so they want me to pay a deducible for the $5.5K-$1.7K which is $3.8K... I don't know about you but wouldn't it be easier for me just to pay $3.4K.  Why do we have insurance again?

And what confuses me further is the hospital called last week, to tell me I owed $45 co-pay (which I paid) for Monkey's birth... they never mentioned wanting $3.8K.

Really, this is terribly confusing.  Wouldn't it save everyone involved money (and time) if the insurance paid against the actual bill and not against this arbitrary "contracted rate".  

I have an e-mail into our HR (hopefully she'll do something this time) and our insurance agent about this, it just doesn't make sense.  I would think HR would be all over it; as my company only requires us to pay $1.5K in deductibles, they pick up the rest.

Insurance reform really needs to start with the insurance companies, and cleaning up messes like this.