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June 2012
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Not every insurance hassle can be properly blamed on Obamacare

By SUSAN ESTRICH Creators Syndicate

Even I was willing to blame the president, or at least his namesake: Obamacare.

What other explanation was there for the fact that it was taking weeks to get a prescription filled, and I was suffering an acute flare-up of my rheumatoid arthritis?

You may have to order the medicine from a pharmacy in Tennessee, one of the staff people at my doctor's office told me. We're waiting to hear. That was a full week after the doctor told me to go back on the medicine.

Now, just to be clear, no one is questioning the diagnosis. I do have RA. I've been on one type of medication or another for the past five and a half years, including the one I've been trying to get. It is not an experimental treatment or an off-label use; it's just expensive.

Before this latest flare-up, I was one lucky RA patient (with a great doctor, which is how you sometimes make luck). After about two years on the shots (in addition to the once-weekly pills), I found myself doing a fair amount of travel, and carrying medicine that must be kept cold and be administered with needles just seemed more than I could handle. So I tried life without the shots, and lucky me, for two years I could mostly forget about this illness.

Then it flared. My doctor saw me right away, did the blood work and then called and said his office would work with my insurance company to get the medicine.

That was two weeks ago. Still no relief. How could it be? How could it take weeks for someone who is insured and in pain and just needs the same medicine she used to take to get that medicine? And I am not just insured; I have double insurance because I have two full-time jobs, along with a few part-timers like this column.

When I told a few friends this story, Democrat or Republican, they all had the same answer: Obamacare. Most of them took pains to point out that given how expensive this medicine is, the insurance companies were probably saving money on purpose by putting my doctor's office and me through needless ringers with the result that I would miss (and they would not have to pay for) the first two doses.

I almost believed them. I really did.

Except none of it was true.

I did not need to get the medicine from a pharmacy in Tennessee. By this week, I was sufficiently upset that I just asked the doctor's office to call my local pharmacist, give her the prescription and see what happened when she entered it on her computer for insurance reimbursement.

This is what happened: The insurance company said they would pay for 90 percent of the cost - the way they always did in the past. I could pay the difference and submit it to my second insurer - the way I always did in the past.

Nothing had changed except the mindset of everyone involved, myself included.

I have no doubt that, depending on exactly what insurance people have, there are many patients who have to find mail-order pharmacies in Tennessee to get their prescriptions filled. Maybe if I did it that way, my co-pay would be lower.

But that should be my choice. For me, there were things more important than the co-pay (which is paid by my secondary insurer anyway): I needed the medicine fast because I was in pain. And my local pharmacy does something that no mail-order operation could do: They know every single medicine I'm on, or have been on, for the past 13 years. So when they get a new prescription, they run it against what I'm already on and let me (and my doctors) know if there is any contraindication.

I got my medicine today. No problem. I am lucky, but I was also foolish. Lulled in the worst way by all the criticisms of Obamacare, I assumed - without even asking - that Obamacare had taken away my choice.

It didn't. Not your fault, Mr. President.

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