Insurance, prescriptions & more…



Recently, a friend ended up in the ED (Emergency Department formerly known as the ER or Emergency Room) and was shocked by how many bills were arriving in the mail. She asked me how I am able to keep my sanity with all of my ED visits, hospital stays, and office visits. The bills must be overwhelming, she said. Indeed, they can be but let me share some helpful tips.

Whenever you are dealing with an injury or accident and you find yourself in the hospital, the aftermath can be overwhelming. You know you have insurance, but are you familiar with your coverage? It is essential that you know what your health insurance covers and what you will be responsible for. And I highly recommend knowing that now. Don’t wait for that moment when you are injured or sick and need to know the answers.

Here are some important questions that will benefit you greatly if you know the answers to the following:

  • What are your deductibles?

This is the amount you are responsible to pay before your plan starts paying.

  • Do you have an “in network” and “out of network” deductible?

Generally, the in network deductible is a lower amount as you are utilizing a provider or facility who is contracted with your health care provider. The out of network deductible is generally a higher amount as an out of network provider is not contracted with your plan.

  • Does your plan allow for visiting nurse care and if so, how many visits per year are allowed?

If you have an injury or surgery that requires in home care followed by a nurse, your plan may have a cap on how many visits per year are covered.

  • Durable equipment – is it covered and at what percent?

For instance, if you need something such as a wound vac, it may only be covered at 80% and you are responsible for the remaining 20%. Wound vacs can be expensive! My wound vac rental was $199.00 PER DAY and I was responsible for 20% of the cost. That doesn’t cover the supplies either which can be an additional cost.

  • Does your insurance cover items such as bandages?

Believe it or not, bandages can be expensive. For the first year I was spending close to $200 a month on bandages and prescriptions.

  • Short term disability – does your plan offer this? Is there a waiting period before it begins? Once it begins, what percentage of your pay will you receive?

If your company does offer STD, there may be a waiting period of several days since your last working day before coverage actually begins. Once it begins, you may only receive a portion of your pay, such as 50%, 65%, etc., and it is imperative that you know this. You don’t want to look at your bank account and discover your pay is completely different than you expected.

  • Long term disability – is this something your company offers and do you need to enroll in it?

Thankfully this was an option my company offered that I elected every year. For a nominal amount, I always thought it was worth it to have peace of mind knowing that if I ever needed it, I would have it. And here I find myself needing it and extremely grateful to have it.

Now let’s talk about prescription coverage. Usually you call in your prescription, pick it up at the pharmacy and you are on your way. I learned a valuable lesson when I first started on blood thinners. While I was in the hospital, it got to a point where it was impossible to draw blood. My veins were shot. My surgeon started me on a well-known blood thinner, however, having the issue of not being able to draw blood, I was switched to another brand which wouldn’t require weekly labs. When I was released from the hospital, my daughter filled my first prescription and called me from the pharmacy to say the cost was $375.00!!  WHAT? That seemed outrageous!

My insurance was refusing to pay for it initially as there were other brands available. After many calls to my insurance company where I explained the reason why I couldn’t stay on the other brand as they would not be able to draw weekly labs, they finally agreed to cover it. I thought, great! Well, not so great because the second time I filled the prescription, it was $75.00.

Now, understand, when you have been in the hospital, had surgery, feel awful, and come home and have to deal with paying an outrageous amount for a prescription you will need every month, it can be a bit much. You know you have deductibles to pay, out of pocket expenses, and you just want to scream dealing with high prescription costs.

As I sat on my couch with my leg elevated, head spinning, thinking about all of these things, I started researching the pharmaceutical company who makes the blood thinner I needed to take. Well folks, smart idea because the pharmaceutical company offers a “savings card” that you sign up for and when you present it to your pharmacy, the cost for my particular blood thinner went from $75.00 a month down to $10.00 a month!

Do a little research and hopefully you can save some money. What do you have to lose? Trust me, I have learned a great deal since my medical journey began and if I can share that with you, to help, I am happy to do so.

The other important lesson I learned is that sometimes we all need help. I have always been the type of person who does everything on my own. I never asked for help, I was usually the one offering the assistance. It is a very humbling experience to realize that you can no longer do many of the things you once did and have these kind, generous people in your life who jump in to help when you need it the most.

Don’t be afraid or ashamed to realize that at some point, you need someone to say, let me do this for you. As I have mentioned, I am blessed with the people I have in my life. Truly blessed. I don’t know what I would have done over these last two years without the love and support from so many kind folks. And you know what I discovered? People like helping you in times of need. It makes them feel good. Sometimes people don’t know what to say when times are difficult. It doesn’t mean they don’t care about you; it just means people are human. When they can drive you to a doctor’s appointment or run an errand for you because you can’t drive, it makes them feel involved and useful. Welcome their kindness and be grateful, I certainly am.

Tell me, do you have any tips on medical “stuff” you can share? You may be able to help someone with your knowledge. 

Until next time, be well and go out and do a random act of kindness.



Photo – my own.






6 thoughts on “Insurance, prescriptions & more…

  1. One tough thing we learned with my husband’s surgery is that just because you’re at an in-network facility, with an in-network surgeon, doesn’t mean the anesthesiologist is in-network and covered.

    Understand that certain charges that the insurance company refuses to pay can be billed directly to you by the provider. Luckily, when we contacted the insurance company and explained we had no choice on the anesthesiologist as everything else was by the book, they covered the portion for which we were directly billed.

    So, my advice: don’t hesitate to contact your insurance company when you are receiving unexpected bills from the providers.


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