Prescription Insurance: First World Problems

Not too long ago a family member told me a short story.  My nephew, Dave, explained to me that one sunny afternoon he was sitting at his local yacht club having lunch with some friends.  He goes on to describe looking away momentarily, when a seagull dives on his sandwich, grabs it, then heads off to devour the fruits of his catch.  In a moment of blind frustration he grabs the closest item he sees, his large clump of keys, and hurls them at the stealth like seagull who is already far out of reach.  Upon releasing the keys from his hands, Dave immediately realizes that he has just thrown, yes, his keys, out over the rocks and sand, toward the water, in a vain attempt to take down a seasoned, sandwich stealing seagull that is so far gone it is an impossible mission.

This is what we like to call a First World Problem.  I do understand that third world problems, such as where our next meal is coming from or the threat of our 13 year old boy being conscripted into a guerilla army, do exist, on some level, in our country; however, for the most part, we live in the safety of a first world society.  Your sandwich being stolen by a bird at the yacht club definitely falls into the first world category.

Health care coverage, especially one that includes some level of prescription medication benefit coverage, is definitely a first world benefit. This is not a politically charged discussion that debates whether prescription coverage should be a universal benefit, or who deserves this or that benefit.  More importantly, this discussion is meant to motivate each and every individual to take responsibility for the insurance coverage that they currently have.

Not less than ten times each day I find myself explaining, describing and educating patients about their personal current prescription benefits.  Individuals will regularly question why they may only receive a certain amount of a particular medication, or why one specific medication was covered last year with my previous insurance and is not covered this year with my new insurance. 

Recently I had a patient describe to me, after they had been on the telephone with a company that processes their prescription benefits, “the person I was talking to couldn’t even explain to me what my insurance benefit is.”  I followed up with a phone call to the same company to help educate the patient and the insurance company had explained the answer beautifully, it just wasn’t what the patient had wanted to hear.

Whether prescription insurance is purchased on the open market, provided to me through my place of employment, provided to me as a young adult less than 26 years of age through my parents employment, provided through a state or federally sponsored Medicaid system or obtained through various other avenues, the recipient of the benefits will be well served to take the time to understand the parameters of their benefits.

Do yourself, your spouse, your children, your parents and your health care providers a valuable service and learn your benefits.  Take the time to review your policy coverage resources and limits.  If you, like millions of others, file your terms and conditions of your health insurance policy in a drawer, pull it out and read it.  If you don't have a copy of your policy, look it up on line.  While reading your policy, be sure to keep a tablet and pen nearby so you can make questions and notes.  Next, find your customer service phone number and give them a call.  Give yourself some time, wait on the phone, then go through your list of questions with the representative.

Remember, troubles with our prescription benefits are considered a First World Problem.  These are problems that we can work with.  When we take responsibility for understanding our own coverage, we will then be in a much better position to understand what benefits we may expect from our providers.

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