I got swine flu. Five days later, I was at death’s door because my evil insurance company wouldn’t honor my
doctor’s prescription. Memo to future revolutionaries: If you require a
firing squad for the executives of the Health Insurance Plan (HIP) of New York, I’m handy
with a rifle.
I wasn’t worried at first. A little sneezing, slightly achy joints.
I figured it was my usual bout of fall allergies. But I felt worse each
day: achier, more congested, stiffer, headache, fevers. The third night
was bad. I went to bed under a pile of comforters, chattering
uncontrollably. Then nightsweats. I checked my temperature: 103.7. When
your temperature looks like a classic rock station, it’s time to see
the doctor.
My ordeal with the insurance company began when I went to fill my
prescription for Tamiflu, an anti-viral medication that is widely
considered the standard treatment for swine (and other types of)
flu.
“Your insurance isn’t going to cover this,” the pharmacist said.
“You would need a pre-approval from your doctor.”
“But that’s a prescription,” I said, motioning to the white slip of
paper in her hand.
“It’s not going to work,” she said, slowing her speech for emphasis.
“This drug is for people who have the flu.”
“Um … I have the flu.”
“You have the flu?” She looked shocked.
Because Tamiflu or another drug called Relenza can significantly
reduce flu symptoms if taken less than 48 hours after the onset of
symptoms, people have been hoarding and taking anti-viral drugs
prophylactically. Given what was about to happen to me, I admire the
hoarders. Smart.
I called my doctor and explained the situation. “Put her on,” my
doctor said.
I offered my cell phone to the pharmacist. She recoiled in horror.
“You have the flu! I’m not using your phone!” She believed I had the
flu enough to shriek like a wee girl. So why did she need to confirm it
with my doctor?
I asked my doctor to call the pharmacy. “Right away,” he
promised.
An hour passed after my doctor and pharmacist exchanged the required
bureaucratic pleasantries. She returned to the counter. “I’m sorry, Mr.
Rall,” she said, “but your doctor is going to have to call HIP to get
their advance approval. It will take him quite a bit of time. It’s
complicated, especially for doctors.”
Especially for doctors? My brain may be baked from a week of
triple-digit fevers, but I want to know:
Why the hell would an insurer make it more difficult to get the main
drug prescribed to treat the number-one most-talked-about disease in
America, one that’s a probable pandemic? Shouldn’t insurers be
shoveling these yellow and white capsules out the door, trying to keep
their own costs down by getting as many flu victims to recover as
quickly as possible?
Oh, and why doesn’t the federal government make Tamiflu available
free? Hey, President Obama: What part of “pandemic” do you not
understand? Another hour went by. My pharmacist’s phone rang. She
winked at me. “Everything should be fine now,” she said.
I was getting sicker just sitting there. My head reeled; an
invisible C-clamp tightened behind each ear. I could barely breathe. It
felt as though there were shards of glass stuck in my lungs. Every
breath hurt. I barely had enough energy to stand up and take a step. My
fingers were bluish-gray. I coughed and caught a ball of phlegm in a
napkin. It was soaked in blood.
Four hours and 12 phone calls after I arrived at the pharmacy, I
went home empty-handed. HIP’s approval still hadn’t appeared in the
pharmacy’s computer system.
When swine flu appeared in the U.S. this spring, the government
prompted hysteria, predicted the deaths of as many as 90,000 Americans.
Now they’re going to the opposite extreme, downplaying a genuine threat
by trying to ignore it. They’re no longer even tracking new cases. And
Obama administration health officials are now selling an official line:
For most people, swine flu symptoms are no worse than those of any
other flu. That isn’t quite accurate.
Lord knows, it’s not like any flu I’ve had. I spent that night
coughing up blood and downing aspirins. By way of comparison, I’ve been
thrown down two flights of stairs — and swine flu is worse. I
went back to the pharmacy in the morning. Still nothing. I called HIP.
Unsurprisingly, their voice recognition voice-mail tree had some
trouble understanding my voice by this time. But finally —
success. Sort of.
After an overnight and about two pints of phlegmy blood later, I had
my Tamiflu in hand. “$87.12,” demanded the pharmacist.
I asked her how much it would have been out-of-pocket, without
insurance. “$112,” she said.
I just read that a recent ABC News poll says that 32 percent of
Americans think the current health-care system is just peachy. Let’s
hope they don’t catch swine flu this winter.
