It's Complicated

This has been one hell of a month.  I lost a brother-in-law, a cat, my patience and my last tenuous contact with Christianity.  And this month, I have all the joys of choosing (drum roll, please) a new health insurance plan. (rimshot)

Evidently Blue Cross and Blue Shield is canceling all of its PPO plans in Texas.  Those of us who are on one, and I liked my plan very much thank you, are all being shunted to a new HMO, which would be fine if either of my doctors took it, but neither of them do.  Given the choice between finding new health insurance and trying to find a new doctor, I will cheerfully take finding new health insurance.

Why not just find a new doctor, you ask?  Well, I will if I have to, but I'd really rather not have to.  Do you have any idea how hard it is to find a doctor who doesn't say, "Oh, it says here you're not on (blank). All my patients are on (blank) so I'm going to switch you to (blank)", when he first meets you?  Or worse, "Your problem is that you're fat. Lose fifty pounds and your wrist pain/bladder infection/sore throat/skin rash/brain tumor will clear right up."  I have heard these actual statements from the mouths of the actual doctors. But I can understand it, sort of.  I mean what fun is a patient who comes in and says, "Hi, nothing's actually wrong, I just need prescriptions for the meds I'm already taking, which I've been stable on for years"?  Not much of a challenge there, hey?  And what intrepid medical professional can resist the urge to say something like, "Well, I can see you're doing fine on (blank), but I'll bet you'll do JUST GREAT on (blank) XR!  And besides, I'll get a major speaking engagement from the drug company if I meet my prescription quota at the end of the month." No, they don't really say that last part out loud.  I just hear it.

So I'm looking for new health insurance.  There are something like 56 plans available.  After chopping off the "bronze" plans, which are basically worthless, it's more like 40 plans.  That is an awful lot of plans.  Yes, there's a company called Molina Insurance which can basically be dismissed outright because no one's heard of it, and a new one called Oscar that doesn't cover either of my doctors, but that still leaves some 24 or so plans.  And despite the fact that everybody from the health care representatives I've talked to on the phone to the President of the United States is telling me I need to compare prices and buy myself the cheapest plan, unfortunately, one glance at the monthly premium and the deductible is not enough to figure out if a particular plan will do the job for me.

You see, It's Complicated.  I have a chronic condition and I take certain prescription drugs. Some of them are Pricey.  The pricier a drug is, the more likely a drug company is to have limitations on it, such as you have to have your doc call and explain why you need it (preauthorization) or worse, you can't take it at all until you've tried all the cheaper ones and failed (step-up therapy).  The former is only a minor annoyance, but the latter is a serious problem if you're me.  Even if insurance companies sometimes waive that requirement at your doctor's request, they sometimes don't.

In case you did not know this, psychopharmacology is basically a hit or miss proposition.  The goal, as I understand it, is to treat the worst of your symptoms with medication that causes minimal side effects, or at least side effects you can live with.  And by the way, when I say "you can live with" I really mean, "you can live with." One of the drugs my doc and I tried had me feeling like it'd be a great idea to carve my arms up with a kitchen knife.  Not because I was depressed or mopey or more anxiety-ridden than usual, just because it seemed like such a good idea.  I stopped taking the stuff and the impulse disappeared within hours.  But yikes.  So when I say, "side effects you can live with," I mean stuff like stomach upset, weight gain, weight loss, and losing control of your right arm so that it flops around on your desk like a fish kicking out its last few moments of life at the bottom of a boat, and yes, that happened too.  I am the queen of strange and entertaining side effects.

For me, every change of meds introduces a really fun six-week period during which I throw up frequently, have a more or less constant upset stomach, eat too much, refuse to eat at all, sleep too much, don't sleep at all, feel like driving my car about 180 on the 635 and have nightmares in which I'm directing a musical about Hitler that features a singing, dancing polar bear and six penguins.  Pick three or four and stir.  Usually they go away after the six weeks, but if whatever we're trying out doesn't work, or works badly, or the side effects are intolerable, we have to either change the dose or try something else--starting the fun all over again.  So this "step-up" therapy, while I understand the logic behind it, is out of the question, really.  I have to find a plan that doesn't require it, and that's getting harder and harder to do.

The good news is, I may have found one.  The bad news is, I haven't yet talked to the insurance company reps yet but the way I read this thing, it sounds like they cover NOTHING until you reach the $3,500 deductible, not even prescriptions. Which means I'm going to need $3,500 for January and February and possibly part of March, and apart from selling my car, I'm not sure where to get it.

And just for the record, I'm navigating all this nonsense with a major brain disorder.  Somebody please explain how that makes any sense at all.

Universal single payer, anybody? Cuz that'd be awesome.