Darth Vader No More

Posted by Mike Merritt in Personal Life on

I’ve had a Darth Vader-like week. No, I’m not evil, or, if you accept the prequels, tragically depressed, and conned by Palpatine. I’m speaking more of Darth Vader’s respiratory issues, although mine this past week weren’t nearly as bad. Perhaps my situation was more closely related to Lost’s late Shannon Rutherford. Luckily, no asthma attack, but I now think I know how it is to go without my medicine for a while, which is strange, since I’ve never been without for more than a day to a day and a half.

Basically, it all boils down to insurance. I was previously on the state’s HUSKY plan, which ended when I turned 21. Now, I don’t have the money to pay for insurance, but neither do my parents. So, I’m on my own. I took a lot longer than I probably should have to consider my options. I had two viable ones:


1) Apply for the state’s SAGA health care. It’s not as good as HUSKY was, but at least I wouldn’t be paying out of pocket for prescriptions; at least, not as much. Like HUSKY, there’s a lot of red tape, to show that you’re indeed eligible for it. Unlike HUSKY, the red tape is a lot longer. Not only do you have to show certain residence and age, and finances, if you make or have too much money, you’re not eligible!

Well, I personally think their definition of too much money is a little ridiculous. For example, I’m trying to be a responsible American. As such, I’m trying to save money for retirement, because it’s never too early to think about your financial security during those years. So, I have a Roth IRA account, and had money in it. I say had, because I no longer have it there. That’s because the state considers that an asset, even though I can’t really spend it except for necessary purposes, like health care or education. So, I was going to take it out and pay off some of my student loans.

I thought about it, though, and decided that I’ve had enough of red tape. The other issue with SAGA is income. I can only make a certain amount per month (roughly $400) before they start counting how much I’ve made, and basically deciding if I have to have a pay down before they start giving me coverage again. That’s ridiculous…what if I want another job? Because, the job with Eastern is great, but at the money I’m making there (and because of f—ing Work Study), I won’t make enough for any future big expenses. As of now, my biggest expense is probably food, followed closely by cable. That’s regular expenses; there’s stuff like the housing deposit, too, but I’ll only have to do it once more in the next eight months.

I would like to get, and once I’m graduated, will need, a license. Which means paying for insurance, since you’re required to have it once you get a license, even if you don’t own a car or drive. With my Eastern job, there’s no way I’d be able to afford it. With SAGA, I’d be hard pressed to get another job, because I’d end up making too much money, and probably lose my coverage, which I also can’t afford. So, basically, with SAGA, I’d get prescriptions for free (well, almost, never asked about co-pays). However, I’d only have one job, which means I couldn’t get my license, because I couldn’t afford the insurance.

So, there’s option

2) Get the university insurance. Not free, but also not too bad. Only $359 a semester…that’s like what my parents are paying per month for their insurance. So, I guess I can’t complain. What I can complain about is the lack of clarity in explaining their prescription coverage. But, to that in a little bit…my hell of a time this week, first.

So, I decided to get the university insurance. It’s costs money that I already pulled out from my IRA, intending to use on student loans (may still do so with some of it). So, I have the money, no problem. Plus, no red tape, or not as much, anyway. So, I email the bursar, telling him I want back on. He emails me back saying the I’m back on, and he has billed me. I pay it, and expect that it’ll take a couple days to get back on.

Problem: I needed prescriptions, during the weekend I was home. Even worse: they were my asthma inhalers. I also need my Crohn’s medicine just as much, but that pain from not having them isn’t going to prevent oxygen from getting to my brain. So, I refill them, and go to CVS last Saturday to get them.  Not covered, they say. So, my dad and I talk. He’s willing to bring them up during the week, unless it’s too late in the week, when which I might as well go home and get them myself.

So, pretty much every day this week, I’ve been going between CVS and the insurance company, trying to figure this out. Finally, the other day, Chickering’s website says I’m covered. Call CVS, but they can’t get it submitted. Call Chickering, who says I’m covered! The women says she’ll take care of it. Call CVS today, still no go. Call Chickering again, and finally get somebody who apparently cares enough to call CVS and work it out.

So, I finally have coverage, and CVS knows the game. Go back on my Chickering/Aetna account this afternoon, and sure enough, CVS has put in a claim for my prescriptions. There’s something strange, though. There’s a co-pay of $30. I was a little angry, since it says no where in Chickering’s brochure of coverage for my school that there’s a co-pay on prescriptions. It does list co-pays in several other categories (usually $10). But, for prescriptions, it mentions nothing! No solid numbers or percents, or even any indication that there may be a co-pay that may vary depending on the price of prescriptions. In fact, Chickering’s brochure is even worded so that it seems as if they pay the whole amount as long as your pharmacy is a participating member in their network, which CVS is.

So, I’m definitely going to call them again, or send an email, or something, telling them they need to be clearer on this issue for the sake of students who may be using this as their only insurance (like me). I’m glad I’ve got the money right now, since $30 a prescription will still add up to a large chunk when all is said and done.

I’m a little interested in seeing what the co-pay will be on my Pepcid AC prescription and my generic Imuran prescription, both of which I can say, with some certainty, that Aetna will be paying less than or close to $20 to CVS. It was that way with HUSKY, and I can see no reason why Aetna would pay much more. What then? Another co-pay of $30, or does it scale down with the prescription price? Or perhaps ones that cheap simply don’t have a co-pay?

Unfortunately, with Combivent and Advair, both are mixed medicines. They’re both comprised of two separate medicines, to be more effective than either alone. I highly doubt they make generic versions of them. So, it’ll be interesting to see what happens when the time comes for my Crohn’s medicine.

For now, I am happy that I now have insurance, and can breath properly again. Still, after the events of this week, and not having any asthma medicine in me since last Saturday night, I know that if I find myself crash landing on a deserted island, that I might be all right.  On the other hand, I do hope that I don’t ever need a full-body respirator!

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