Did you ever grumble to yourself: “My insurance won’t let me…” buy this drug, have this procedures, do this test?
Did that seem unusual to you?
Do insurance companies typically practice medicine?
No. They (may) pay for medication, or surgery, or tests. They do not prescribe.
So if your insurance refuses to pay for what your doctor thought was in your best interests, what are your options?
Sometimes paying for it yourself ends up costing you far less money than trying to get your insurance to pay, and then you picking up the co-pay.
I prescribed Lovenox®, a blood thinner, for one of my patients who
had developed a blood clot in the leg. She and I were both horrified to
realize, when she went to the pharmacy, that her co-pay for an 11 day
supply cost her a little under $600.
When she eventually followed the advice of an insurance broker and checked the cash price, she was told the cash price could have been $276.39. Or, at another pharmacy, even less - $138.45.
How does that happen?
We like to think that there is some regulation in the cost of pharmaceutical drugs. Apparently not, when the prices can be so widely different – and even less if you pay cash than if you pay your co-pay and insurance covers the rest.
The same pricing seems to apply to Xrays and other tests as well. My patient was told $40 cash or $69 co-pay for the same Xray.
The insurance broker’s advice: always ask three questions about drugs or test prices.
- what is the cash price
- what is the insurance price
- and if it is a drug, look up the price on the app Good Rx (http://www.goodrx.com/)
My patient is not alone in her experience.
You can read more about this topic on the Discount Drug Network website: http://www.discountdrugnetwork.com/paying-out-of-pocket-for-prescriptions-can-cheaper/
Huffpost Health Living has information as well: http://www.huffingtonpost.com/david-belk/health-care-costs_b_4066552.html
ProPublica – Journalism in the Public Interest – has a marvelous article here: http://www.propublica.org/article/a-health-reporter-struggles-to-find-out-the-cost-of-his-sons-prescription
The Arizona Center for Advanced Medicine offers a free 15-minute phone consultation with one of our practitioners, to determine whether we can help you reach your health care goals. Please call us at 480-240-2600 to schedule that consultation.