Over the past few Fridays I’ve been making appointments with a variety of my doctors. I’ve seen an optometrist, a dentist, and my general care practitioner. Also, I’ve been back and forth to the pharmacist a few times to get some prescriptions that I need. This Friday I’m going to see a nutritionist, too. But I have to tell you, while I’m going to visit these various care providers, I’ve noticed that my insurance pretty much sucks in all respects.

Below is the bulk of a text of an e-mail that I sent to one of the leaders at my job. The purpose was to explain all of the problems that I’m having with the insurance – frankly, some of this stuff is insane…

Prescriptions: The most aggravating issue that I have is the prescription coverage. My doctor prescribed a certain drug for a condition that I have, but he gave me free samples to use first. Once the free samples were completed, I tried to get the prescription filled and the pharmacy told me that the insurance company didn’t cover the medicine (first they said I wasn’t in their system – a recurring theme as you’ll see). Instead, I have to take two generics – the free samples that my doctor gave me were working very well, too. I don’t mind taking the generics, but now I’m inconvenienced with taking two pills instead of one.

Additionally, I tried to fill the generic prescriptions and one was approved with no problem while the insurance company wouldn’t immediately approve the second one. They wanted additional information from my doctor, which the pharmacy requested. The Pharmacist said that the process should take no longer than 2 – 3 business days, so given the upcoming holiday, I might not be able to get my medication until after Labor Day. [Note: I wrote this e-mail on Wednesday, September 2nd]

Gym Reimbursement: The insurance company has a Healthy Lifestyles program that I am enrolled in. This program offers $150 for reimbursement of gym membership expenses if you go the gym 120 times in a given year. When I switched to my new gym in March I asked if it was covered in the program and they said yes. On a following call with the insurance company, they told me that the visits to this gym would only count if they were made in between certain times of the day (basically when we’re at work). That effectively kills my ability to claim this reimbursement and it makes their program useless.

Request for Information: In one of these calls to the insurance company, I asked them for a package of information that detailed all of my benefits because I, unfortunately, lost the package that the secretary gave me when I was hired (I lost it in the move to Tinton Falls). They sent me a package for those members who are 65+ years old living in Somerset County. I called them back and told them that they must have the wrong guy and that I was 28 and living in Monmouth County while being employed in Mercer County. They apologized and sent out a new package…the same package as the first time. So I threw out both packages since I’m not a senior citizen living in Somerset County and gave up trying to ask them for a listing of my benefits.

Delta Dental: When I went to the dentist two weeks ago, I had to wait an hour before I could be seen by the doctor because the assistant was told by Delta Dental that I wasn’t in the system. Apparently, she called a few days prior to my visit and I wasn’t in the system then, either. I gave her our office contact information, but I was in the dentist’s office at 8am for an 8:15am appointment so there wasn’t anyone in our office who could help that early on a Friday morning. After waiting on hold and going back and forth with the insurance company, I was magically found in Delta Dental’s system and able to see the dentist at 9am.

Optometrist: The insurance company subcontracts their vision coverage to a vision company. I went to the eye doctor about four weeks ago and it took them over an hour to figure out how to bill me AFTER I had seen the doctor. They were on the phone with the insurance company who took no ownership over their contract with the vision company and said that I wasn’t even in their system (they eventually found me). So the eye doctor’s office called the vision company, who said to contact the insurance company. This went back and forth until someone finally got on the phone and figured out what to do and how to bill me.

Pearle Vision: When I was getting my glasses at Pearle Vision, the person helping me pulled up our company’s specific plan with the vision company and it cited that we had a really great plan that covered some parts of the equipment (great discount on lenses). Then when he called the insurance company to get some confirmation number, they wouldn’t speak to him and put him through to the vision company, who bounced him back to the insurance company, who ultimately said that we had no equipment coverage. The folks at Pearle Vision were baffled since their information (which had been updated about two weeks earlier) clearly showed all of the equipment coverage that we should be getting on our plan.

This is where my e-mail ends. However, there is an addition to this mess…

Nutritionist: It turns out that my nutritionist visit (which is essentially preventive care – the stuff that everyone in America should be engaged in) is not covered either. You see, my nutritionist is not registered as a medical care provider and thus can only enter a certain billing code to the insurance company. Well, my plan doesn’t accept that billing code – they only accept nutritionists that bill as medical offices. So I have to pay for this visit out of my pocket.

Here’s my question – if I’m paying for health insurance and I have all of these needs that aren’t being met by the insurance company…why am I paying for health insurance again?