I was reviewing my claims under Premera Blue Cross Blue Shield for my recent medical emergency during my ‘help mom out’ visit to California.
My out of pockets for the six prescriptions was $36.71. I am very very grateful indeed for good medical coverage. The ambulance bill to be transported 13 miles in the dead of the night was $2,589 and change – I am waiting to hear what my portion of that will be. No word yet on the emergency room charges.
While I was reviewing the pharmacy stuff, it caught my eye that CVS Pharmacy in Healdsburg CA (store # 1173) charged my insurance $223.93, the retail prce printed on the informational sheet was $57.99, and my out of pocket was $8.65. What? I looked deeper. 10 Ondansetron 4 mg tablets cost my insurance company $223.93. Over $20 per tablet charged by CVS to Blue Cross to grant me relief from nausea. I want to emphasize I was NOT responsible for the huge dollar amount, my cost was less than a buck a pill.
Still – The charge to my insurance company was completely outrageous. I wanted to know if an error had been made, or if they were being scalped.
So I called Premera. I spoke with John, who listened to my story and seemed to understand my concern was not that I’d be charged anything extra, but that this cost seemed out of line with what was provided, especially in view that the retail price was printed on the medication sheet as a still expensive $57.99.
John called Express Scripts (the branch that deals with pharmacy stuff for Blue Cross in Healdsburg). They confirmed the $223.93 was customary and correct.
When I encounter things like this I can’t help but wonder how long it takes for that $223.93 takes to get magnified and passed down to you and me as monthly premiums for our insurance, if we are so fortunate as to have insurance. Because somebody, somewhere, is eating that charge. And I have a very difficult time believing it costs $22 per tablet to manufacture Ondansetran (generic for Zofran) and still turn a healthy profit.
Ouch. I think our out of pocket for the mom-stress induced medical emergency is going to be in the neighborhood of $3,000. About 20% of the total bill which is nearing $15,000. I am indescribably grateful we have health insurance.