On December 11 I took my son to the local clinic of one of the area's major health conglomerates, who then sent a prescription to a local pharmacy. When the pharmacy called my insurance company, the were told that unless the clinic called them to "pre-authorize" the medication, they would only cover the issue of a single dose at a time (with co-pay for each dose). I immediately went to the clinic to relay this information, and over the next five days the pharmacy further contacted the clinic twice, all to no avail (the clinic did not call the insurance company). I then faxed the clinic administrator on the 16th (have never received any kind of response), went to the clinic again in person on the 18th, and finally bought a single dose (with a co-pay) on the 18th.
At this point I contacted my insurance company directly, who told me exactly what the pharmacy had said from the beginning: if the clinic would only call in a pre-authorization, they would cover the issuance of six doses (with a single co-pay), but they had absolutely no record of contact by the clinic. I faxed this to the clinic administrator and again never received a response.
My family health insurance premiums are almost $8,000/year, paid with my social security and military disability pensions, for which the COLA over the past five years has been laughably small. Furthermore, these tiny COLA increases were in actual fact immediately taken away by a corresponding increase in Medicare payments. That's right, senior citizens have in fact received no increase at all.
Many think of the oil companies as obsessed with greed, but out of curiosity I checked the Vanguard (one of the largest mutual fund companies in the US) site to find comparable profit margins. Is there a single senior citizen among us who could even imagine this kind of return?
Yes, these conglomerates portray themselves as "non-profit," but that means only that they conduct many self-serving functions during which they remind everyone ad nauseam of "how much they care about us," after which the Big Shots share the remaining money.
Robert E. Ballay