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My Insurance Drove Up an RX Price by 100%

So, late last week I got my bivalent Covid boost (just in time for new variants to dodge it, of course), and flu shot on the same day. And, as I expected, I felt crappy. I expected that to last a day, and had the liquids and OTC I needed to cope. And when it lasted longer than expected and got worse, I just assumed the double-dose was kicking my ass.

Saturday I crashed into bed in the middle of a game session. Sunday I was only alert for short bursts. Monday morning, I realized both my ears hurt the way they do when I have an ear infection. And since I had self-misdiagnosed for the whole weekend, it was suddenly at the constant-pain-and-occasional-icepick-in-the-ear-level-agony stage of ear infection.

No bueno.

So, off to my local favorite urgent care, who have always taken great care of me when I can’t wait a few days to see my Primary Care Provider, but don’t need the E.R. It was one degree above freezing, awful slush was falling from the sky, and my wife had to drive me. The Urgent Care was nonstop back-to-back with children with respiratory infections, but got me safely in a waiting area by myself, took my vitals when a medical assistant had a spare moment, and eventually a nurse practitioner managed to see me. She checked, confirmed I had ear infections in both ears (and quipped “How do you DO that?” as they have seen me for this more than once), and that it needed immediate antibiotics, and sent me to pick up a prescription they called into my pharmacy. Eardrops, because they’d be gentler on my system than an oral. But, the nurse practitioner assured me, if I didn’t feel better in day I should let her know, and she’d write a new script.

This had taken a few hours, much of it in the feeing dark, but normally this is the point when we can pick up the RX at a drive thru pharmacy, go home, and begin to recover. But if that had been how it shook out, I wouldn’t be making a bog post out of this.

So we went to the pharmacy, and waiting for the prescription to be ready. And when it was, the pharmacy tech asked if we knew how much it would cost, and we noted we did not.

“$180,” she said.

“What?! For eardrops?!”

“Yeah.”

“Did you run our insurance?”

“Yeah. Let me double check for you.” [Click, click click.] “Yes, I double checked your insurance is current, and ran it. It’s $180. Do you want me to fill this, or put it on hold so you can call the doctor or your insurance?”

We put it on hold, and called the clinic. We explained, and the assistant said she’d go talk to the nurse practitioner, and could we hold.

We held. Sitting in a packing lot, in now sub-freezing temperatures, ice slowly forming on the car, we held. Thank goodness I *could* afford $180 for eardrops if I had to… but I couldn’t afford to do so unless I really did have to. And I love my wife, and love spending time with her. But this was eating my entire day.

The assistant came back on the line, and explained that the eardrops were only $90 without insurance… but yes, she had checked, and they cost $180 with our insurance.

Wha… what? We could get it at half the cost if we DIDN’T use the insurance I had spent hours selecting, and paid for out of pocket every month as a freelancer? It was MORE EXPENSIVE with my insurance?!

Yes.

But, she was sure that was still more than we wanted to pay, so they had called in a new prescription. Let them know if there was any problem with it.

So we waited a bit, drove through the pharmacy window to see if the new RX was ready. It wasn’t. So we waited a bit more, hoping roads weren’t getting slick. (They weren’t, thankfully.) We drove through again, and this time they had it.

“How much?”

“$25.”

“How much without insurance?”

“$40.”

“Great, just checking.”

And, apparently, while the double-cost/$90 upcharge is rare… prescriptions in the US costing more when you use your insurance is NOT rare. “Clawbacks” may affect close to 25% of US prescriptions, often running $5-$10 higher than the uninsured cost. That doesn’t explain the huge difference for me, which may be a result of a pharmaceutical manufacturer offering a huge discount to uninsured customers, and my insurance not covering the drug at all, so I both have the higher price and no help covering the cost.

So, yeah. The system is broken. And, when getting a new RX, check both the insured and uninsured price.

Speaking Of Money
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Storytime: The Insane 20-Person, 14-Hour, Multiple ttRPG Game System Adventure I Played In At WorldCon 1984

Over the weekend I was reminiscing about my first big convention, the 42nd WorldCon when I was 13 years old, and how I wandered around by myself in LA with hundreds of dollars for most of a week. For those curious about the whole post, it’s at the end of this blog entry.

But one of the things I have gotten the most feedback on from that story was mentioning I played in a “20-player, 14-hour game of mixed Basic/Expert D&D, 1st ed AD&D, 2nd ed Boot Hill, & Metamorphosis Alpha.” And, yeah, that was pretty crazy. Several people have asked me to talk more about that game, and it was darn near 40 years ago, but I’ll give a quick rundown to the best of my recollection.

There were lots of “Open Gaming” rooms at the 1984 WorldCon, spread over numerous hotels, which were set aside for people to just organize their own game sessions. I am sure there were organized tournaments and scheduled games as well, but I didn’t interact with that end of things at all (and still rarely do). Instead, I had a backpack with my favorite characters, a bunch of dice, some snacks, and a couple of rulebooks, and looked for people interested in striking up an ad hoc game. That was how gaming had been handled in the tiny convention that was my first taste of cons in Norman the year before, so that was what I expected to be the “standard.”

And, there was a pretty robust 24/7 gaming scene in at least one of the hotels, and I got a few games in. But the one I remember best started about 5-6pm, I think on Thursday (might have been Friday), and came together because a charismatic young man (I thought of him as “an adult” at the time, I’d guess now he was somewhere in his 20s, likely college-aged) stood on a chair in one of the biggest open-game rooms, and shouted he would run a game for any number of people, allowing any characters, from any game system, all together.

There was a lot of slack-jawed disbelief, but when he started setting up multiple fishing tackle boxes of dice, miniatures, and terrain, a bunch of us got interested and went over to see what was up. There were 20 of us players (give or take), and only 3 open round banquet tables in the room. I mentioned there were spare tables a couple of floors down and a young woman (older than me, but I thought not by much — I do not remember her name… I don’t think though it might have been Susan, but she had what I thought was an adorable Canadian accent) said we should go steel them. And she was leading the mission, because she was going to playing an Expert Thief.

So a few of went with her, rode an escalator down one level, cleared and grabbed two round tables no one seemed to be using, rolled them down the hall, had 2-person teams brace them on the escalator for a ride up, and rolled them down to the game room.

The GM had the now 5 tables arranged in a circle, stored his stuff on the floor under them, stood in the middle, and explained the game. First, he really meant any character, any game system. We each got to do one thing in a round, and he’d deal with each of us in our native game system. If there was one monster, the Metamorphasis Alpha characters would fire gyrojet rounds at it, the various D&D players swing swords and fling spells, and the Boot Hill gang (all of one table IIRC) could fan revolvers and unload shotguns. I’m pretty sure he played fast and loose with the rules, all the rules, but it never interfered with the game.

I played a high-level cleric who worshipped Saint Cuthbert of the Cudgel, and carried said saint’s cudgel as an artifact. There were several D&D characters of various editions and classes, a flying psychic telekinetic blue whale and it’s ally a white 4-armed gorilla covered in chitinous armor plates, a Boot Hill outlaw gang (maybe called the Broken Trestle Gang?), and I am absolutely forgetting several folks.

The GM got straight to the set-up, explaining that each of us had a dream where we were told by a wispy voice that only we could save everything, and the End was coming to destroy the Demiurges, destroying all of reality, and we had to stop it. And then our characters woke up on an island covered in various ship, train, and carriage wrecks, with a huge ruby tower at the center. We roleplayed introductions briefly, dealt with the fact several characters thought they were still dreaming (or had gone mad, or were high on bad moonshine, or all of the above)… and then just as we were trying to figure out who would be in charge and what we were going to do, creatures that looked like the garthim from the Dark Crystal came wading out of the water to attack us, and they had small turrets on their shells with machine guns in them.

It was quickly clear that if you didn’t have cover, the machine guns would chew you up. And if you did have cover, the guns would chew it up in a few rounds. So we tried to cover each other and fell back toward the ruby tower. But we couldn’t get in the front door. So, the flying blue whale told us all to climb on board it, and it flew up the tower… and through a big crack in the sky.

And we went reality-hopping on a psychic mutant blue whale. If someone’s character died, they ran to go grab food (we all pitched in), then usually came back to watch, at least for a few hours.

I absolutely can’t remember everything that happened. We stayed up all night, eating cold pizza and drinking warm Pepsi, and I had the time of my life. There were undead WWII battleships, living “evil eyes” that would fly into the wound of a dead person to become a “third eye” and possess them, floating islands, reality and alternate planes curling back on each other, and at least a little time was spent in fantasy, Old West, and Generation Ship in Space settings. One of the D&D rogues ended up with a sawed-off Boot Hill shotgun. One of the Boot Hill gang members got a ray gun from Metamorphasis Alpha. The psychic blue whale sacrificed itself to save us when a spiked ghost train attacked us in the Astral Plane by crashing into it head-on, while an AD&D wizard riding it broke his Staff of the Magi on its cowcatcher.

We worked out that The End wanted all our worlds to stop existing, and had discovered our worlds all existed because the Demiurges willed them to, and all the Demiurges were gathered in one place, and it was going to kill them, but we could stop it. And the flying eyes all belonged to an extradimensional creature that served as a lookout for the End. It had a weird name, like “That Which Disapproves,” though I doubt that’s exactly right.

We played all evening, all night, and well into the next morning. Character after character died, but we knew it was okay, because if we stopped the End, they would live again, and if we didn’t we’d all cease to exist.

We ended up with just 5-6 of us left, in the Modern Era, in LA, hunting the End through the halls of a hotel… and finally found it. It was a scrawny, unimpressive, short boogeyman, lurking outside a room at the hotel. And it was looking through the door at… us.

Us, the players. We were the Demiurges. The End wanted to kill us, and if our characters didn’t stop it, we, as real-world people, would be killed by it. The idea thrilled me…and freaked me out.

But the last few heroes (including my cleric) destroyed the End, ensuring that the worlds of adventure would continue forever. And we realized we could, as our characters, go into the room and meet ourselves, as players. And in that moment, having gorged myself on junk food and soda and been awake for something like 36 hours and playing for 14, I believed. But, we decided in-character that might freak out the Demiurges, so we left.

Also, there was something about a dartboard. There was a folding-cabinet bar-style dartboard in that hotel conference room for some reason, and it came into play in the story of the End, but I can’t for the life or me remember how.

And the game ended. We exchanged long-distance phone numbers and address and promised to keep in touch and I, at least, had lost all that info by the end of the weekend.

Then I went and slept in the Anime Room, because it was closer than my hotel room.

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For those of you who want some context, here’s the story I posted on Social Media about my time at the 42nd WorldCon.

I don’t have kids, and I am well aware that things were different 40 years ago. But apparently even people my own age are shocked to learn my mother was fine with me wandering around LA on my own at age 13 with $500 on me.

Though to be fair, $300 of that was traveler’s checks.

It was for the 42nd WorldCon, and I was almost 14.

My mother went with me, and we had a hotel room, but we mostly checked in on a notepad in the room. We rarely saw each other.

She was filking. I was gaming.

I went to a Elfquest #20 Howl/release party. A woman dressed as Nightfall flirted with me and gave me first-ever romantic kiss (from someone I didn’t even know the real name of).

Saw the anime Lensman movie.

Was part of a banquet table heist so we could fit more gamers in a room.

Rode to Disneyland with C.J. Cherryh.

Ate breakfast at a diner counter at 4am, discussing Return of the Jedi with some nightflyers who weren’t, AFAICT, die-hard geeks.

Played a 20-player, 14-hour game of mixed Basic/Expert D&D, 1st ed AD&D, 2nd ed Boot Hill, & Metamorphosis Alpha.

Bought my first junk metal wall-hanged sword.
Broke my first junk metal wall-hanger sword.
Bought my second junk-metal wall-hanger sword.

Got offered, and declined, my first beer from a stranger.

Ordered a delivery pizza just for me to eat watching movies, for the first time.

Saw, for the first time, ALIEN, Dawn of the Dead, Heavy Metal, Flesh Gordon, Dark Star, Sapphire & Steel, The Quatermass Experiment, Mad Max, Life of Brian, Clockwork Orange, and Zardoz. The video quality was often terrible, and some may have been taped off movie screens.

That was my 2nd or 3rd scifi convention ever, and it would be a high-point until I got to a Gen Con in the late 1990s.

I was a BIG 13-year old, in both height and weight. I’d never been unsupervised while away from my home town before. We didn’t have cell phone, or pagers.

Now as it turns out, I was fine. I can’t say if it was genius parenting, or luck, but the experience was formative for me in a lot of ways. Not the least of which was I saw how total strangers reacted when someone whipped out a big wad of $20s, and stopped doing that.