Altheia, Inc.

October is Health Literacy Month.??I’ve been in the industry for 30 years, and I still don’t understand the layers of complexity in our healthcare system - so I can’t even imagine how the average person navigates it each day.??As we wrap the month, I’d like to share my story: I got healthcare coverage on the state exchange a few months ago.??(I’m going to save my rant on the cost of coverage for another day.)??Navigating this experience was painful at best, and I needed lots of help along the way that mainly came from friends & family.??But I ended up with a high deductible plan that I thought would suffice. My first experience under the plan is with a prescription drug – Restasis for Dry Eye.??First things first, we need to repeat the prior authorization that I already did with my last health plan.??(Because when you start with a new insurer, your data does not go with you.)??So after a thorough review involving my [already busy] doctor, I get a response in the mail (yes, Theodore Tanner Jr. – the mail), that the drug will be covered and that yes, it is on formulary.??Okay, so off I go to the pharmacy to pick it up.??Monthly price with insurance???Over $600.??Keep in mind this is the on-formulary price, and that we are not curing cancer here.??Price for the non-formulary,?generic?option???$700.??(For reference, I paid $20 the prior month with my old insurance.)??The pharmacy feels sorry for me and steers me in the direction of getting a manufacturer coupon, which ultimately takes $100 off the price.?? Second experience I need an abdominal ultrasound.??Off I head to an in-network hospital to have it done.??I think you know where this is going.??Insurance price???$740.??Price if I don’t have any insurance???$180.??I choose the second option, even though the payment does not go against my deductible. Some observations:??1) When calling my insurer’s call center, the agent tells me not to worry because these high prices will go against my deductible.??Umm, what kind of logic is that???The absolute prices should make sense in the first place – and not be wildly different by plan option.??2) Why does my data not automatically transfer with me as I move from plan to plan???I came close to a care gap having to repeat the prior authorization process – a pain for me and my doctor.??3) How do people know that there’s a coupon or discount somewhere in the ether???Wouldn’t it be nice if someone were proactively mining my complete data set to proactively offer me savings opportunities?? Most people want to be in the driver’s seat with their health.??But if a thirty-year veteran is perplexed, we’ve got a long way to go.??I applaud the efforts of all companies – like Altheia, Inc. - trying to make this better.??