I had the opportunity this last week to see our dysfunctional health system up close and personal. This situation was absolutely mind numbing to say the least and is another example as to why we need consumer involvement in the healthcare purchasing system. Here is the synopsis of what happened. I am on a maintenance drug for HBP and have been for some time. In discussion with my doctor, I asked for a 180-day supply since I travel and want to have the convenience of only renewing twice a year. My doctor has no problem with writing the script for the 180-day supply. When I went to pick up the prescription from the pharmacy (in this case, Bakers), I noticed the bottle was small and not full. I asked the Pharmacist (she was the actual Pharmacist) if that was indeed the 180-day supply as requested. She stated that no, it was a 30-day supply. When I questioned why, she told me that my insurance would only permit filling a 30-day supply. I explained that my insurance does not “out rank” my doctor and I wanted the script as it had been requested by my doctor. Her response was that it would not be covered by my insurance and the cost would be substantially higher. The cost was only $10.37 for the 30-day supply. I insisted on the 180-day supply and she relented and proceeded to fill the prescription as requested. When it came to paying for the script, she informed me that instead of the $10.37, the prescription was now nearly double. My cost for it was $20.48. She didn’t even seem to comprehend the irony of the facts. The actual cost of each pill went from about 35 cents to only about 11 cents. A tripling of price and the inconvenience of filling each month. It really makes one wonder how many other items we are over paying on and don’t even realize it.

My other story along these lines was when my doctor ordered a CAT scan and told me that they would contact me with details of where and when. When I was contacted, I asked a very simple question of the person. It was, “How much is this going to cost?” She was surprised and asked what I meant. I explained that usually when I purchase something, I like to know the cost. She still didn’t understand but told me she would have someone contact me. About an hour later, a person from the business office at Lakeside Hospital called and asked how she could help. I explained that I just wanted to know the cost of the CAT scan. She said that would depend on who my insurance was with. I explained that my insurance has nothing to do with this and I just wanted her to tell me the cost. Finally, after about 5 minutes, she said the cost of the procedure would be $1,200. I thanked her for the information and told her I would be in contact. I then called Village Point Radiology, explained the exact CAT scan needed and asked their price. She quoted me $400 if I paid the day I came in. I said great but she stated that my doctor would need to order. I agreed and called my doctor’s office and explained the difference in cost. They asked if they could call me back in a few minutes. When they called back, they told me that Northwest Imaging would perform the CAT scan at a cost of $300 if I paid at the time of service. So, by making a couple of calls, I was able to save about $900.

Do we have a problem? I think it is apparent. Unless we educate our consumers, these types of charges are put into the system and ultimately drive up the costs of insurance. These are just two isolated incidents that I have recently encountered and I am sure there are many more.

Leave a comment if something like this has happened to you.