Omeprazole, also known as Prilosec — used to treat gastroesophageal reflux, can be purchased over the counter for $15 or by prescription for $8. So can someone please explain how the same medication in liquid form for a baby’s reflux can cost upwards of $50 per month and not be covered by insurance?
How can I already have spent several thousand dollars on health care costs this year, meeting our family’s out-of-pocket maximum, yet cannot even appeal to my health insurance company to cover the omeprazole — because, “Sorry, ma’am, it’s not listed on our formulary”? How can I, as a nurse myself, make countless phone calls to the doctor’s office, pharmacy and insurance and get no closer to finding my screaming baby some relief?
There is no good explanation for any of this, besides the regrettable fact that health insurance companies peddle in the business of carefully orchestrated, frustration-producing care denial. And for those of you wondering, of course I paid the $50, and of course the omeprazole made a night and day difference for my baby.
Because of my experience and the experience of families who suffer care denial in far more egregious ways, I raise my voice against a system that places profits ahead of patients.
Tricia Bunderson
Lehi