Last year, I was one of the many small business owners and sole proprietors who had their health insurance cancelled, as the big insurers used the specter of approaching health care reform to clear their rolls. My brother and my boyfriend, also self-employed, were in the same boat.
I started looking for new insurance on Connecticut’s health insurance exchange, Access Health CT, but once I realized I wasn’t going to qualify for a subsidy, I decided to buy my insurance on the private market, because there were more options available.
After looking at various available plans, I decided to go with ConnectiCare, because I could get a plan that was comparable to my previous insurance coverage, and offered dental, which my previous insurance didn’t.
Before I signed up, I checked two things carefully: that my current doctors were in-network, and that all my current medications were listed in the formulary as being covered.
Everything checked out, so I bought the insurance.
All seemed well until last week, when a summer cold triggered the worst asthma flare-up I’ve had in years. I sounded like Darth Vader in the middle of a panic attack.
When I went to use my inhalers, they’d expired two years ago — thanks to taking generic Singulair daily, my asthma is usually pretty well controlled so I’d barely ever used them.
I called my doctor’s office and asked them to call in refills, which would normally be no problem. But then I got the calls back from the nurse. First my insurance wouldn’t cover Ventolin, only ProAir. My doctor tried to fight for Ventolin, because that has a dose counter, so you know when the cartridge is almost empty. ProAir doesn’t. But my insurance company wouldn’t budge.
The next day, as I was still gasping for air, apologizing to my students for my constant wheezing and coughing, and struggling to function, I got a message on my cell. “Your insurance won’t cover Advair — even though the doctor has argued with them.”
Advair was listed on the formulary before I signed up with ConnectiCare. But as it says on the bottom of the list, “This formulary list is subject to change.”
The day I found out that I wasn’t going to get my Advair, I left the house at 8:50 a.m. and didn’t get home until 9 p.m. because I taught morning and afternoon/evening writing workshops. When I returned home that evening, I collapsed into bed, feeling like I was about to die.
The next morning I tried to make an appointment to see my doctor to see if I could get some alternative steroid, because I wasn’t sure how I’d survive the weekend. Unfortunately, the only appointment he had was while I was teaching. I spent most of the weekend in bed, exhausted and gasping for breath.
On Sunday, my sister-in-law called me from England. When she heard that my insurance company wouldn’t cover something as basic as Ventolin or my usual steroid, she was gobsmacked. “Don’t they realize you could die from asthma?” she said, with no small amount of anger, followed by lengthy conversation about the insane healthcare system in this country vs. the National Health Service (NHS) in Great Britain.
People here love to bash the NHS and “socialized medicine,” but even conservatives in the U.K. look to our country and think our healthcare system is inhumane — particularly because they know that it’s still possible to get private insurance and see consultants privately — and that insurance is much cheaper.
The anti-Obamacare folks constantly use the catchphrase “the government will come between you and your doctor,” but they ignore the reality of what has been happening every day in the U.S. since long before Obamacare was even proposed — that it’s insurance companies who come between us and our doctors. What’s more, these same insurance companies are using the cover of healthcare reform to try and shaft consumers even more than they were doing in the past — and politicians are happy to pocket their campaign contributions and let them do it.
When I finally got to see my doctor on Monday, he gave me some samples of a steroid, because at that point he and I were both sick of playing games trying to figure out what my insurance company (the one to whom I’m paying monthly premiums) was going to cover, and he wanted me to be able to breathe again so I could function effectively at the many jobs I work to support myself and my family.
I also saw my neurologist last week for a follow up appointment, and she told me that she’s hearing similar stories from her patients.
What I want to know, from our legislators, our healthcare advocate, and the state insurance regulator is: How can insurance companies get away with listing drugs in a formulary before you sign up for their insurance, yet refuse to cover them after you’ve committed?
Doesn’t “truth in advertising” apply to insurance companies? Or do Connecticut’s politicians just pander to them, too?
Sarah Darer Littman is an award-winning columnist and novelist of books for teens. A former securities analyst, she’s now an adjunct in the MFA program at WCSU, and enjoys helping young people discover the power of finding their voice as an instructor at the Writopia Lab.
