Insurance or No Insurance by Rebecca Kelly

Insurance or No Insurance?

It is more and more a steady game of “cat and mouse”.  Some insurance requires high deductibles on top of a high monthly payment, some insurance dictates what medications are covered or removed from coverage based on formularies, and yet some insurance even makes you jump through insane hoops to see a particular doctor for care.  

This is my insurance story….we had insurance through my husband’s employer.  Each year, the cost increased…again and again, until a couple of years ago it became more than our monthly house payment, with high deductibles to boot.  We had no choice but to “shop” around.   We checked many avenues, some we did not qualify due to income status, which is another joke – if we were divorced and filed separately I would qualify in a heartbeat!  We decided on a cost sharing plan as the best fit budget wise and what was best for our family.  The cost sharing plan pays for Dr visits but not prescription meds, so another challenge had to be addressed as diabetes needs constant prescriptions.  For insulin, before Covid, we drove to Canada to pay a more affordable, more appropriate price tag.  For supplies, I researched online and found a company based out of FL called ADW Diabetes.  I am on a monthly shipment for reservoirs and infusion sets at a cost of about $128 per month.  For sensors, I checked into Costco.  If you are uninsured, which is what a cost sharing plan falls under, they will run medications through their prescription program, and although it is not “cheap”, it is more cost effective than the online options I researched.  

It is unfortunate that we have to negotiate our healthcare in such a way that we can afford the choices of everyday life and still get the medicines we need without breaking the bank.  The root cause that is not being addressed is the pricing from the manufacturers.  It is fact that it costs $6 to make a vial of insulin, but the cost over the years has ramped us up to an average, whopping $300 per vial!  

In the midst of the madness, we have to take control of our own health, decide what is acceptable and unacceptable, and do our own research to find solutions that we can manage.  I went through all the emotions of anger, fear, and frustration of “what do I do next”.  I refused to settle on “this is how it is” or “this is how it’s going to be”.  My husband and I even thought of the extreme of filing for divorce just to be able to afford healthcare!  How crazy things can get if we let them push us to a negative tone!!  Life is made up of all these events and the choice is to be proactive or to be put on the defensive. 

The American Heritage Dictionary of the English Language defines health insurance as “insurance against expenses incurred through illness of the insured”.  Wow!!  If companies would look at this simplest of explanations, they would see it does not say “for the profit of corporate executives”, or “for the highest bidder on the money trail”, or “for quarterly bonuses that fall in the hundreds of thousands”.  NO….it is to help with “expenses incurred through illness of the insured”….how sad and broken our healthcare system has become and how jaded it has made those of us on the other side.  

It is more and more a steady game of “cat and mouse”.  Some insurance requires high deductibles on top of a high monthly payment, some insurance dictates what medications are covered or removed from coverage based on formularies, and yet some insurance even makes you jump through insane hoops to see a particular doctor for care.  

This is my insurance story….we had insurance through my husband’s employer.  Each year, the cost increased…again and again, until a couple of years ago it became more than our monthly house payment, with high deductibles to boot.  We had no choice but to “shop” around.   We checked many avenues, some we did not qualify due to income status, which is another joke – if we were divorced and filed separately I would qualify in a heartbeat!  We decided on a cost sharing plan as the best fit budget wise and what was best for our family.  The cost sharing plan pays for Dr visits but not prescription meds, so another challenge had to be addressed as diabetes needs constant prescriptions.  For insulin, before Covid, we drove to Canada to pay a more affordable, more appropriate price tag.  For supplies, I researched online and found a company based out of FL called ADW Diabetes.  I am on a monthly shipment for reservoirs and infusion sets at a cost of about $128 per month.  For sensors, I checked into Costco.  If you are uninsured, which is what a cost sharing plan falls under, they will run medications through their prescription program, and although it is not “cheap”, it is more cost effective than the online options I researched.  

It is unfortunate that we have to negotiate our healthcare in such a way that we can afford the choices of everyday life and still get the medicines we need without breaking the bank.  The root cause that is not being addressed is the pricing from the manufacturers.  It is fact that it costs $6 to make a vial of insulin, but the cost over the years has ramped us up to an average, whopping $300 per vial!  

In the midst of the madness, we have to take control of our own health, decide what is acceptable and unacceptable, and do our own research to find solutions that we can manage.  I went through all the emotions of anger, fear, and frustration of “what do I do next”.  I refused to settle on “this is how it is” or “this is how it’s going to be”.  My husband and I even thought of the extreme of filing for divorce just to be able to afford healthcare!  How crazy things can get if we let them push us to a negative tone!!  Life is made up of all these events and the choice is to be proactive or to be put on the defensive. 

The American Heritage Dictionary of the English Language defines health insurance as “insurance against expenses incurred through illness of the insured”.  Wow!!  If companies would look at this simplest of explanations, they would see it does not say “for the profit of corporate executives”, or “for the highest bidder on the money trail”, or “for quarterly bonuses that fall in the hundreds of thousands”.  NO….it is to help with “expenses incurred through illness of the insured”….how sad and broken our healthcare system has become and how jaded it has made those of us on the other side.  

1 comment

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