Insurance company! Where is the love?

This op-ed piece was thoughtfully written by Ramona Fefe (pictured below) who has been working at Oakland Vision Center Optometry since the year 2000. 

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I have been working in health care since the year 2000.  Since then, I have seen changes in the insurance industry and have witnessed how it has affected people’s lives and well-being. Personally, I have also experienced the ups and downs of being a patient and the ups and downs of being on the provider side.

There was a time when I looked forward to getting old and retiring into my golden years. Now it scares me to think that I may not get to choose what's best for me as I age. For example, my mother had to apply for a supplemental to her Medicare last year. She picked one of the lesser expensive plans due to income. At the time of her mammogram (with gown on and prepped for the procedure), she was told that her co-pay would be $700. Either pay now or don’t receive a mammogram was told to mom. No mammogram that day (or anytime soon). Isn’t a mammogram preventative care? Why the $700 co-pay?  

I am scared for our current seniors. The get caught in the blender of medical plans, prescription medications and co-pays. Please let me tell you about one of Oakland Vision Center’s long-time patient. He is 80 years old and had been taking a certain medication for glaucoma for over 3 years. Each calendar year the formulary list for covered medication changes for insurance plans due to cost saving measures. Unbeknownst to him, his medication would no longer be covered  . . . only after taking the bus to the pharmacy to get denied a refill. And here is where I come in. The pharmacy say’s “not covered.” No problem since he’s been on the medication before, and can get an authorized exception due to the fact that he is allergic to preservatives.

After a 30 minute conversation, the outcome was that the insurance company is requiring Oakland Vision Center to trial 3 medications (that he has allergies to since they all have preservatives) which requires 3 more pointless visits and not to mention much agony and potentially ill side effects to our 80 year old patient.  What I don’t understand, his insurance company KNOWS he has taken this medication prior to the formulary change and he’s responding well. There is nothing I can do. No understanding on the insurance company’s part. How do you sleep at night knowing that this man cannot get medication that could possibly be used for saving his vision (glaucoma) or perhaps for his heart, Mr. Insurance Company? 

I have worked hard so far and with many years left before I am able to receive my senior citizen Tuesday discounts. I don't want to be caught up in the red tape of insurance companies and pharmacies, either trying to make a buck or save one. In a perfect world we would all be able to get the services we need, the medication that would help us, or the procedure done that could save us -- without the worry about breaking the bank. But this is the world we live in, where humans are dollar signs, and care and compassion . . . a thing of the past.

Sincerely, 

Ramona Fefe