Tuesday, September 01, 2009

Thank you Arthur

Arthur is the nice customer service rep at my insurance company who informed me, while Sam was wheezing in my other ear, that my retail limit has been reached and I am supposed to refill "maintenance medications" through the mail and not at retail stores...in order to "maximize benefits."

It just would have been nice if someone had told me...you know...in advance of the asthma attack.

Thankfully, Arthur completely understood that I work for county government and therefore relevant information isn't necessarily shared...and put through a one-time "exception"...that will be ready in 24 hours. Yeah...I know. But that's "the best they can do" and I just have to understand (as I watch my son turn blue).

All this to maximize benefits.

Breathing is a pretty significant benefit, don't you think?

Yeah...me too.

And you know what maximized benefits mean? An inhaler...that costs $41...insurance covers $21 of it. I've refilled TWICE ALL YEAR. So I can certainly see where there might be significant savings by not allowing me to refill them at retail prices. I mean sheesh...I just might bankrupt the whole dang company!

I honestly contemplated saying, "I have two kids that don't breathe...they're really not as much fun as those that do...so I'd like to keep the breathing ones...you know...breathing."

I really should have.

**(Sam did not expire. The attack was soccer-induced and relatively minor...and because I love my control, I always have a backup inhaler.)**

UPDATE:
Exception denied. They'll put it through to a higher decision-making authority and they may possibly grant it. So that's another 24 hours.

The online forms have been filled out. IF approved, the medication should SHIP in 10-14 DAYS.

Guess Sam is supposed to just hold his breath until then.

6 comments:

Kellie said...

Our insurance just switched over to a similar dealy-a-bob. Though, my understanding was the an asthma inhaler WASN'T maintenance. Maintenance is like high blood pressure medication and birth control (as if!) ... but an asthma inhaler isn't something usually used on a scheduled regular basis, but needed ASAP when ya need it. Maybe Arthur should start asking questions ... cause that makes NO sense at all.

Arthur and I would not be friends ... Glad Sam is ok.

Jelly-Filled said...

I'm so glad Sam is okay. It's ridiculous they would make you wait 24 hours for a medicine for an asthma attack. Thank goodness you're so on the ball.

Michele said...

I hope you call and complain to your insurance company! That sucks!!! I mean, the kid is having an attack!

Kellie said...

I asked my pharmacist friend about this and he said Arthur sucks... I agree. I think we're all on the same page.

Runelady said...

Okay, third time is charm, I hope. God I hate being computer inept. Call your physician and ask for an inhaler sample as a back up until you get the mailed one. Usually doctor's have them on hand. THEN email the president of the compnay, the president of the US and every damned Congressman you can think of and PROTEST. Insurance companies have too much power and this type of thing needs to stop immediately. We aren't talking precedents, we are talking about a little boy's life!!!

Trevor said...

This is where I'm grateful for the National Health Service. Here in England this would all be looked after without the need for any form of insurance. Glad Sam's okay.