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Friday, October 29, 2010

Insurance companies

Insurance companies!

Don't get me wrong, I love my insurance company - except for a few little details. They seem to treat asthma as a one size fits all disease, which of course it's not.

Their medical board has decided to no longer cover Xopenex (levalbuterol). It's more expensive than Albuterol, so of course they want everyone to use the cheaper version.

Son #2 (severe asthmatic) is sick again. Asthma Doctor was out of the office, so we went to the Pediatrician. He sort of squinted his eyes at Son #2 and said, "I know how he is, we better start him on Prednisone." I looked at our medical file in his hands, it must have been close to 3 inches thick! He's on to us....

He knows he has to be agressive in treating Son #2. The only problem is his Xopenex inhaler and nebulizer vials have just expired. And insurance is no longer covering them. Pediatrician suggested I call the pharmacies and ask for the cash price. A Xopenex inhaler will be $58, the vials for the nebulizer will run $130.

So, now what? They can write a letter to the insurance company and ask them to reconsider and cover this medication for Son #2, since Albuterol is not effective on him. But where do I come up with $188? I also need to get the Prednisone prescription filled, luckily that's cheap. Add to that a Z-pack prescription. (Plus $25 for the Pediatrician visit) I also need a refill on my Advair disc, as does Kitty for her Advair.

And I wonder where all my money goes?!

At least insurance is still covering his Xolair prescriptions - it used to be $1000 a month, but that's what it was when Son #2 started receiving injections almost 3 years ago, I'm sure the price has gone up since then.

Anyone else have fun with their insurance company? And what do you do? I think I'll take a deep breath and hand over my debit card from my flex plan. (We set aside thousands of pre tax dollars every year from insurance to pay for co-pays and presciptions). But we always end up using the money before our year is up. We usually spend it all in 4 or 5 months.

But, as I always tell the kids, "things can always be worse"! We'll figure it out. Even if we have to cut back on the grocery budget and eat 'creatively' until the next paycheck.

Well, time to finish last minute preparations for Halloween. And of course tomorrow night I'll be checking Son #2's candy, to make sure he didn't get anything with tree nuts in it. Fun times!


  1. That’s very sad and disappointing news about insurance companies. My mom also experienced the same case, also with her most expensive maintenance for heart problem, and we were really very disappointed about it. Anyway, insurance companies should ask for their clients’ opinion first before doing or dropping any services or else they’ll lose not just their credibility but clients as well.

    -Hershel Duffey

    1. Yes, it's frustrating. I'm sure they want the least expensive medication for their patients. Our insurance just stopped covering Advair. We were forced to switch to Symbicort or Dulera. *Sigh*

  2. My cousin used to have serious asthma problems but I’m glad that she didn’t experience what you did. I know this happened two years ago and I was wondering if you’re still with the same insurance company. You can search for an insurance company who’ll treat you better and can really adjust to your needs. Anyway, I hope you’re feeling better now and hope you have less asthma attacks. :)

    ^- Melody Rosenbaum -^

    1. Hi Melody, thanks for stopping by! Unfortunately, insurance comes with the job, so we don't have an option for switching companies. They have stopped covering 3 medicines so far that we take, so we were forced to try other asthma medications.

      It's still frustrating dealing with insurance companies.

      The new medications seem to be working well for now. Who know what they will stop covering next?!

  3. I guess I am lucky in the UK as I currently am eligible for free Rxs. Even when I am no longer eligible, I can still apply for a Pre-Payment card, or pay no more than the fixed prescription charge (currently £8.05).

    However, we have some issues with licensing in the UK. The license for Xopenex has been withdrawn, and no other Beta-2 agonists (short-acting) are available in MDI form. Terbutaline, for instance, is only licensed nowadays in its dry powder form as a Turbohaler, which I cannot use. I have to make do with salbutamol which is alright but in no way ideal. I wish I could get Xopenex over here but it isn't licensed in the UK!

    I'm sorry that you have to struggle with costs and all. Then there's travel to hospital and doc appointments etc. etc. etc....

    Fingers crossed for lower prices in the USA :)

    1. Hi Lizzi! Yes, it's frustrating. We now use albuterol, I'm not sure it works as well as Xopenex. But - what can you do?

      But, our family mantra is "Things can always be worse!" There are a lot of people worse off than we are (no insurance, no family support, etc.)

      Some days are just better to deal with than others :)