The US Healthcare System Desperately Needs Change

Wendy Caroline avatar

by Wendy Caroline |

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covid-19, calm, healthcare

I am drained. My current situation astonishes me. The United States healthcare system must change.

Over the past month, I’ve dealt with some severe and unusual health insurance issues. Before I continue, I want to make it clear that this is not an attack on our healthcare workers or any one person, nor am I endorsing any political party. I’m simply frustrated with the way our system is set up.

Let’s start with the backstory. My company switched insurance providers at the beginning of the year. This, of course, involved shuffling around all of my specialty medications to the appropriate preferred pharmacies. No big deal. I refilled my medications with the correct pharmacy, hit my deductible, and went on my merry way.

Two months later, I received a bill for my husband’s doctor appointment. Strange … we had met our deductible. So, I gave my insurance company a ring to see what is going on. That turned into a two-hour conference call with my insurance rep, three different pharmacies, and me. This completely disrupted my day, including a significant chunk of my work hours and mental energy, but the issue didn’t even get resolved.

No one could tell me where the money had gone from all the prescriptions I had already filled this year. I waited two weeks for some forms to show up but they turned out to be no help. So, I got back on the phone. Many hours, days, and phone calls later, I still had no answers.

Then, all of my pharmacies called to inform me that my benefits had ended in December. How is it possible that my benefits ended in December 2019 when they began in January 2020? I confirmed several times that they had my updated insurance information. To cover my bases, I also confirmed with my insurance company that the insurance — that I have been paying for all year — is in fact active.

Finally, one of the pharmacies walked through every single number in my insurance information. That’s where the problem was. The member ID was correct, but the prescription benefits numbers were wrong. A human, or possibly computer, error. That was the source of all this trouble.

The second I found this out, I called and spoke to my healthcare rep. The rep informed me that I had somehow been referred to an out-of-network pharmacy. Once the medications I had filled were claimed on my insurance, they would be counted against my out-of-network deductible instead of my in-network deductible. The incorrectly inputted insurance information prevented the pharmacy from informing me that they were out-of-network when I filled.

The whole situation has boiled down to owing thousands of dollars due to a clerical error. I am deeply thankful for Cystic Fibrosis Foundation Compass, which is handling the situation. At this point, I am in over my head. I am being taken advantage of and my health severely compromised.

So far, I have been out of life-saving medications, including Trikafta, inhaled antibiotics, and Pulmozyme, and others for two to four weeks. My “CF cough” is back. I am constantly short of breath with burning lungs. This is not OK. I have seen friends pass away due to insurance complications or not having access to health insurance. How many more people need to be affected before we see that healthcare needs to be accessible to all, not treated as a privilege?

» Follow my journey at “The Living, Breathing Wendy.” «


Note: Cystic Fibrosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Cystic Fibrosis News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to cystic fibrosis.


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