My (earnest, irate) thoughts

…was convincing the world he didn’t exist. Do you find it as fascinating as I do… how far regular people will go, how completely they will give up their soul, in order to have a steady income?

I take for instance a recent experience with my insurance company, UnitedHealthcare, and specifically its pharmaceutical division, Medco. I had the pleasure of speaking to Maria.

Some background: I have been battling a pretty severe chest cold for about two weeks (my own fault for not listening to my husband and getting more sleep, wearing socks, wrapping my neck with a dry towel, eating yogurt and drinking hot tea when it was just a little cold — thus, there blossomed thick phlegm and a heaving, hacking, awake-all-night cough). After a few days of the really bad symptoms, I went to my doctor. He listened to my lungs and peered into my throat and called it “bronchitis.” He wrote prescriptions for a powerful antibiotic, and a cough suppressant/expectorant that was supposed to loosen the mucous in my lungs allowing me to have “productive” coughs, but also suppress my body’s urge to have dry (unproductive) coughs.

When I took these two prescriptions to CVS, I was charged $97. For exactly 28 antibiotic pills, and 14 cough pills. For 42 pills over 7 days, $97. That’s like $2.30 per pill. I asked twice if they had run my insurance. The pharmacy tech assured me they had. But over the next seven days, in the swirling delirium of illness — including the fact that after all my pills were gone, I was still coughing violently, albeit productively — I became incensed. Righteous indignation is my usual state of mind, so it’s natural I would return to it when I was feeling better, kind of.

First, I was angry at the doctor for prescribing me this exorbitant medicine that clearly didn’t work. I went to him after 10 days had passed and told him I’d had to drop $100 on his last two prescriptions, and could he please find something cheaper this time. He was horrified. He didn’t come right out and say the pharmacy hadn’t run my insurance, but he seemed so shocked that I started to suspect just that. (Plus, my mom had spoken to a friend who is a nurse practitioner, and she outright said the pharmacy couldn’t have run my insurance.) He wrote me a prescription for a generic Z-pack, which meant five more days of even more powerful antibiotics — and instructions to eat yogurt to replace the good bacteria, and drink tea with honey — and thrust several free samples of prescription cough syrup and nasal spray at me.

By then I was thrilled with my doctor, and filled the ($10) prescription at Walgreens. Naturally I became convinced that CVS had stolen from me by charging me full price for the medications. I went back there and huffily demanded they check and see. A different pharmacy tech typed for about 10 minutes on the computer and then printed out the prescription labels again. He pointed out where “UnitedH” had paid for their part of the medicine. He said my co-pay was $60 for each medicine, which is why I’d had to pay $60 for a $100 antibiotic, and full price ($37) for the cough pills. I asked, “Is that normal?” He said, “No, a $60 co-pay is pretty outrageous.”

By then my fury toward the pharmacy faded, and got channeled into my insurance company. This is when I had the chance to speak with the lovely Maria. I won’t call her a dolt, but I will quote her below:

Me: Maria, could you be a dear and explain to me exactly why I had to pay $100 to cure my bronchitis?
Maria: Well these prescriptions are Tier 3, and that’s why—
Me: Tier 3? I’m sorry? Could you explain to me in regular English exactly what that means?
Maria: All prescriptions are divided into different tiers. Yours are Tier 3.
Me: Yes, but what does Tier 3 mean?
Maria: Prescriptions that fall under the Tier 3 category are Tier 3 if prescriptions are single-source prescriptions with no generic. (Yes, this is exactly how she talked.)
Me: Augmentin Rx doesn’t have a generic, so it’s Tier 3.
Maria: Yes. Tier 3 medications only have one manufacturer. So Augmentin Rx is a Tier 3 medication, and Tier 3 medications have a co-pay of $60.
Me: So if a medicine is new or hasn’t been copied by someone else, it’s considered Tier 3. And the co-pay for Tier 3 is $60.
Maria: Yes, that’s right.
Me (after a pause): Maria, doesn’t it strike you as slightly outrageous that a person would have to pay $100 to cure bronchitis?
Maria: Well, Tier 3 medications have a co-pay of $60. So with Augmentin, which costs more, you had to pay $60. But with your other medication, the price was $37, so you had to pay $37, not the co-pay. Because we can’t charge you more than the medicine costs.

She had me there.

Me (with a hint of sarcasm): I should hope not… Listen, Maria, can I ask you an honest question?
Maria: Yes, ma’am.
Me: What can I do to avoid this in the future? I mean, what do you suggest I do to avoid Tier 3 medications and $60 co-pays? Will my doctor know what ‘Tier 3′ is?
Maria: Well, you can call us when you’re at the pharmacy and we can tell you what your co-pay is.
Me: I think my pharmacy can handle telling me the price I’m responsible for. What I’m talking about is avoiding the problem of being prescribed something expensive in the first place. Do you understand my point?
Maria: Oh.
Me: Do you have a list of Tier 3 medications or something?
Maria: Oh! Yes, we can send you a guide in the mail.

I’m not even going to get into how stupid it is that we allow insurance personnel without medical degrees to dictate health care decisions.

And despite how this may seem, I’m really not trying to single out Maria as like, the most offensive company-policy apologist ever to work the phones. For me, Maria is just the latest in a long line, part of a much larger trend that I’ve noticed whenever I have a problem with anything — from a credit card bill, bank statement or cell phone bill with a mysterious “fee,” to health and dental insurance companies having myriad “reasons” for not covering something.

American capitalism has devolved into outright thievery. Sure, they call it a “maintenance fee” and it’s only $1.50, but my $1.50, times 2 million customers, equals $3 million. Three Million Dollars in nonsense “fees” that, correct me if I’m wrong, have no basis in real services and amount to stealing. And it works, and it works well, because it’s over the phone or it’s in the mail, there’s no face-to-face interaction or accountability.

So it’s easy to understand the mindset of the company. What I’m trying to understand is the perspective of the person who’s actually talking to me, and how they can sleep at night, knowing they are aiding and ebetting theft from regular folks like themselves. Do they justify it with the corporate rhetoric they hear in the orientation video and company memos? Are they brainwashed into thinking their company is actually fulfilling the needs of its customers?

Probably they are just average folks, reading off a little sheet Scotch-taped to the wall of their cubicle that explains all the appropriate non-response responses for every situation. When customer says: ‘Why do I have this maintenance fee on my bill?’ You say: ‘Company policy blah blah blah…’ They don’t think about it too much, justifying it with how they have kids and a mortgage and how answering phones is better than working outside in the heat. But at least bricklaying, or whatever, is honest. It’s a respectable and decent way to support a family, doing something tangible to justify the bread on one’s table. What do these corporate parrots actually do to earn the bread they eat and the roof over their heads? Less than nothing, because they attempt to justify the insatiable greed of the insanely wealthy. To me, their actions are about as bad as those of the insanely wealthy themselves, who are undoubtedly deeply unhappy and probably suicidal because they’re all-too-aware of what they actually are. Their wealth is its own punishment, because it’s empty, and they’re empty, and they know it.

But what about the middle-class automatrons who help the rich get richer, and call it “working for an insurance company” while they steal pennies from their friends and place it directly into the hands of the greedy pigs at the top? I’m not pretending to be horrified that this happens. I mean, people have been stealing from each other since the beginning of time. What bothers me is that regular people choose to work for corporations who pay them a pittance to say that what those companies are doing isn’t theft, and that we who are stolen from often don’t understand what just happened.

If this were Medieval Europe, these people would be one of the king’s men, the guys on the horses who rode around collecting the “taxes,” which mysteriously went up every time there was a war that had to be funded. And they terrorized the feudal peasants, burning their thatched roofs, stealing their cows, and worse. But at least they knew they were thieves, and those they stole from knew they were thieves. But now, because it’s all done in a very pleasant tone of voice, and it happens over the phone or with a politely worded, vaguely confusing letter in the mail, we don’t call it stealing? Hogwash.