Monday, April 20, 2009

"Try and fail" policy (otherwise known as bring your own tissues)

I recently got a new insurance carrier. Why, you ask? Well, I adored my old insurance carrier. Their name may or may not rhyme with "Pigna" but they were wonderful. They had super co-pays, they covered all my medicines, but there was one tiny problem - they literally doubled their premiums last year. So, because I don't have an additional $160 per month to spend on insurance, I had to switch. My options were kind of limited - I could go back to Green Cross (not their real name of course) and have a deductible that I never met because I don't get sick that often or I could try their new HMO version, Green Choice where you get to choose your health plan! and choose your own doctor! and have co-pays! Plus, they were the same price monthly that I was paying with Pigna so I switched. That was back in January.

I have been a happy Green Choice customer. I have had zero complaints...until last week. If you aren't living under a rock, you realize that the allergy season this year has been one of the worst ones ever. In SC, we had a late snow. While that meant we got TWO snow days (woot!), it also means that the grass and the tree pollen are blooming at the same time instead of being spread out. It's been pretty stinkin' miserable around here. V and Tim and I could be the poster family for an allergy commercial - sneezing, itchy eyes, scratchy throat...the whole nine yards. I take a WONDERFUL allergy medicine that I love but I don't need it all the time so I already had about 2 weeks worth. It still had 5 refills, so when I ran out I called it in to the pharmacy and went to pick it up. The pharmacist informed me that I had to get "prior authorization" from my doctor before my insurance would pay for it. I have had that happen before once or twice with Pigna, so I wasn't worried. I called the doctor first thing the next morning and asked them to call the insurance and authorize it so I could get my medicine. A few days pass - no word. The nurse finally calls me back and tells me that Green Choice will not approve my allergy medicine. HUH? They have a policy - it's called a "try and fail" policy. Here's how it works: they ask the doctor to write me a prescription for an over the counter allergy medicine. I have to physically take it to the pharmacy and get them to fill it so it shows up in their records. After trying that for 21 days, if it is not working, the doctor can write a prescription for my old allergy medicine and they will pay for it. I believe that is the stupidest thing I have ever heard in my entire life. Only an insurance company would get away with that. I know I couldn't go into my school and tell a parent, "I know the reading method that I am using is not teaching your child to read. However, I have a a try and fail policy. If the method doesn't work for 21 days, then I will try a reading program that will work. Have a nice day!"

So, today is day 3 of 21. So far, I'm still pretty miserable - in addition to the allergy medicine that doesn't work, I got a sinus and double ear infection during the week that I didn't have any allergy medicine, so I'm on an antibiotic as well. Fun fun stuff. In the mean time, here's my theme song...

From Snacktime (kids album) by Bare Naked Ladies


  1. this is way so true.......Green Choice works this way.............Sorry you are feeling so spoiling grandma

  2. WOw...I have never heard of such a are right that is completely silly....I miss you by the way...havent "seen" you around lately, very much anyway...


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