Healthcare In America:
Doctor - I see that your gscsttigom isn't working as well as I'd like. I'd like to start you on pjehhdntpf instead.
Patient - Okay, do you know how much that's going to cost?
Doctor - Sorry I've got no idea.
Patient - What do you mean? Like give me a ballpark. Is this a $20/month? $100/month? $500/month? Refinance my house for a month's supply?
Doctor - Well, it's probably not "refinance your house" level.
Patient - Umm ... Okay ... That leaves a lot of room in there still.
Doctor - You'll just have to talk to your insurance.
Patient - ... Okay
Later
Patient - Hey insurance, my doc wants me to start taking pjehhdntpf, can you tell me how much it is going to cost?
Insurance - Sorry, I have no idea.
Patient - What do you mean no idea?
Insurance - well, we won't pay anything until your doctor gets a pre-authorization. And then how much we cover is based on the diagnosis codes, your deductible, the specifics of your plan, whether you get it from an in-network pharmacy or not ...
Patient - fine, so give me a best case
Insurance - free if it's approved and in network and you've hit your out of pocket maximum of $100,000
Patient - ... Really not helping here. So assume it gets approved and I've hit my deductable
Insurance - which pharmacy?
Patient - idk ... Umm the CVS down the street
Insurance - Okay that's going to be $5000/month
Patient - ... Wait, WHAT?
Insurance - turns out it's on our exclusions list so we don't cover it unless you get it waved onto the formulary upon appeal
Patient - but.... I have insurance. Why aren't you helping me pay for my medicine?
Insurance - we don't allow that medicine on your employers' plan. You should use gscsttigom instead.
Patient - I'm on that one right now. It doesn't work.
Insurance - well you'll have to appeal it, but you can't do that until after you get a formal denial.
Patient - and how long does that take?
Insurance - well, if your doctor does the preauth paperwork, they'll make a decision about it within 14 business days, unless they need to come back to your doctor for more information. Then they'll mail you the decision within another 7 business days from (insert the location farthest possible away from you in the continental US). Depending on the decision you can appeal the decision, which the appeals process can take a maximum of 180 days, after which you can appeal it again which takes a maximum of 365 days.
Patient - and if I need to start taking the medicine now?
Insurance - well you're free to do that out of pocket and file for reimbursement later.
Patient - at $5000/month?
Insurance - no it'd have to be at the out of pocket price. For that CVS, it looks like it'd be $15000/month
Patient furiously googling "how to move to a civilized country"
Googles "pjehhdntpf price in Mexico" - $12.50 for a 90 day supply.
