Getting Old Is Not For Sissies: But You'll Get OLD Faster With HealthNet!

 If there was ever a designed road to hell, look no farther than dealing with Wellcare by HealthNet and probably any other healthcare insurers.

Today, after the fourth refusal, I spent over two hours trying to get a medication prescribed by my doctor. This time my urologist. If you don't think this stalling isn't designed to frustrate us think again. All I wanted was, if they were refusing one medicine, to find out what WAS covered?

I know we've all been there. Profit takes precedence over health.  

On March 7th I saw my urologist after a urinary track infection {UTI} gripped me and wouldn't let go. This has been a recurrent problem since 2014 when my cancerous prostrate was removed. It returned 18 months later and was treated with 8 weeks of radiation. I later found out this can kill nerves to the bladder in between five to ten years. It did seven years later and after a hellish year of self catheterizing I had a Superpubic catheter tube and external bag placed in and on me. The bladder nerves had died and after 13 UTI's in a row this new procedure ended some worries. Because you have an object coming out of your abdomen you are still subject to UTI's.

Now my urologist felt additional surgery was counter-productive and prescribed medicine for pain management. I didn't care as long as it worked. It did but only for 10 days. I was only given 15 pills and was running out.

The infamous "formulary."

I received a letter from HealthNet on March 20, 2025 dated March 10, 2025 (I guess sent by Pony Express) denying coverage of this medicine. They would only give me 15 pills until I found a substitute. Me, I should find a substitute? Isn't that their job? I'm no pharmacist. So I called the number to find out what WAS covered. This started the seven levels of hell.

The "formulary" is a list of medications Wellcare covers.  Unless you know the name there is no cross reference to help you.  There certainly is no cross-reference to find similar alternatives. I did find the name, listing of available milligrams, the pricing tier they charge for and under requirements, you need a PA. This I discovered meant prior authorization but no explanation what it meant or done by whom. I had never dealt with this before and you would think a doctors prescription was enough. Apparently not.

I talked to 6 people for over 2 hours and still was not able to get my medication. I was put on hold trying to talk to people whose English was clearly not their first language, who kept shifting me from one department to another. I hung up after 2 hours and 20 minutes when I was told I now had to go to the Commercial Department and were going to put me on hold yet again. I just couldn't bare the thought. I hung up.

I then called my urologist and, as usual could only leave a message. Seriously, I don't know why we have phones anymore. NO ONE ever answers or returns a call unless it's a bill collector.

So, here I sit with no medicine, yet again, on the threshold of excruciating pain that I can't get medicine for. When I go to Immediate Care, yet again, it will cost them far more to pay for that visit than authorizing my prescription.

Teddy Roosevelt, a Republican, tried in 1904 to give Americans universal healthcare, like Europe. We're still waiting 121 years later. And Congress, Medicare is NOT an entitlement, we've paid into it our whole working careers! So, let's find a solution, everyone would appreciate it!

Thank you for reading my blog. I invite you to take the time to read earlier blogs where my emphasis is to explore the ways art and design affects our daily lives ... and always has. I share with you what inspires me with the hope that it will inspire you as well. Comments are always welcomed! 

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