What is wrong with Healthcare in the US?

With recent health issues in our household, there have been a couple of hospitalizations and a whole new pharmacy on the dresser top. We are senior citizens and have Medicare plus a supplemental health plan and an Rx plan that is supposed to reduce the cost of prescription medications. The Medicare and supplemental plan have prevented any out of pocket expenses so far, though one of the doctor’s from the first hospitalization has billed Medicare for something for which they have already paid and Medicare declined to pay it a second time obviously. It still shows up on our summaries with a zero balance, but shows a declined expense. The pharmacy side is another story. We pay a significant monthly fee to have the medications at least partially paid for by the insurance plan, a three tier system that lets us know what our co-pay is for each med in the tier, but if we ask the pharmacy what the cash price is, it is often half what the co-pay would be. If we use the insurance, we are paying not only the monthly payment for the plan, but double the cost of paying cash on top of it. This just doesn’t make any sense to us. Fortunately, we know to ask what the difference would be and have paid cash for several of the scripts that have been called in.

Also, scripts never have a refill number on them anymore and most, except antibiotics, come in 90 supplies so a large bill every three months instead of spreading it out. To get a refill, you must contact the pharmacy who then contacts the physician for authorization on a medication that you know you will be required to take long term (not pain meds, but maintenance meds to prevent the condition from worsening). If you call the physician’s office, the robot voice tells you to contact the pharmacy.

The surgeon tells you to call and schedule a follow up in 4 weeks and the soonest they can see you is 5 weeks or more.

Our system is broken and we are among the lucky ones to be able to have and afford insurance to cover our issues. I don’t know what the solution is, but certainly not the way it is being done now.

I would love to hear your comments on this post.

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