Is it just me, or is my employer being really messed up?

[Capp]

I find myself really irritated with this recent decision by my employer, and I was curious what other people thought of it. Am I being unreasonable? Or is this messed up?

I work for one of the major health systems* in my area, and us employees are forced into health insurance plans that penalize us for using services outside of the system. They recently made a new rule that employees of the system are no longer allowed to use the outpatient pharmacy at the hospital. Apparently there is a clinic somewhere in a less convenient location that has much more restrictive hours that we are allowed to use.

I work night shift and the hospital pharmacy is the only 24 hour pharmacy, so I will have to forgo sleep if I ever want to pick up a prescription. Alternatively, there may be a 24 hour Rite Aide or something out there, but even if there is the cost will be much higher since it is out-of-system.

Also, apparently my family is also now banned from the hospital pharmacy. My wife was heading from her doctor's office to the hospital to pick up a prescription and they called her while she was en route and basically said, "So where do you want us to send this prescription that just came in, 'cause you're not welcome here anymore."

They didn't give much of a rationale for the change, but seemed to be suggesting that the goal was to reduce wait times. I guess if you deny services to a group of people than your wait times will improve, but it seems to me the same rationale would work equally well to justify discrimination against any group. I think in a way, it would sort of be less unethical for them to deny services to any other random group since we are the one group of people who are forced into insurance plans that penalize us for using out-of-system services.

So, am I being unreasonable?

*I didn't mention the employer by name in case it is against some policy here on Allnurses.

[KrysyRN, BSN]

Basically we are talking about a group of our patients and how we choose to treat them. This group happens to be employees as well as patients, but my whole point is to ask why does that matter? How is it right to treat a patient crappily just because of who they work for. I personally would think that was wrong whether it was Chic-fil-A employees or healthcare workers from a rival system that were being discriminated against.

Also, I guess I shouldn't have mentioned my own situation as an example because that just stirs up people's natural instinct to make things personal. "Quit whining . . . Get over it. . . Etc." The change technically doesn't impact me personally because I don't have any current prescriptions anyway. I was saying that I personally think all patients deserve to be treated the same regardless of who their employer is. Obviously the consensus is that I am wrong.

The costs you pay, the location you go to for meds, and the medications that are covered by insurance -- are all determined by a pre-written contract between a health insurance plan [example: United Health Care, Humana, Medicare (which may be managed by plans such as United and Humana)] and an employer (ex: ABC Hospital). What you aren't allowed to do on your health insurance plan might be something someone else IS allowed to do because of that contract. Your employer probably negotiated a far better deal with the inconvenient pharmacy in an effort to save money with the pharmacy portion of your plan. Unfortunately, there is a trend right now where employers are passing on more and more of their insurance costs to their employees, regardless of how much they were able to negotiate at a lower rate with their chosen health plan(s).

There is much more to this, and I hope this makes some sense.

[Lane Therrell FNP, MSN, RN, NP]

Capp,

I feel your frustration. And I agree that the situation as you describe it is "messed up." I blame the fatally flawed insurance infrastructure for these kinds of situations. I've always resented the idea of "in-network" and "out-of-network" as an underhanded way to deny access to care. Especially in rural areas. Don't get me started! Anyway, in your situation, it seems like there ought to be a mechanism for exceptions -- such as granting employees special pharmacy privileges as part of your employee benefits package.

[TheDudeWithTheBigDog, ADN, RN]

Don't wear your name badge. How do they know you work for the hospital?

[blondy2061h, MSN, RN]

Does the pharmacy with the less convenient hours they're forcing you to use have delivery per chance? My hospital's outpatient pharmacy has very limited hours and wouldn't be available to nightshift at all but they do deliver.

[ComeTogether, LPN]

They are paying for your insurance, or a good amount of it. It is not unreasonable to have stipulations. You are free to choose an independent plan.

[Katillac, RN]

I think of all the passive-aggressive attacks poorly disguised as well-meaning attempts at psychoanalysis from a stranger on the internet that I've seen, this was by far the funniest. I think the last sentence really ties it together. If you were writing this as a satirical commentary on people who make those kinds of attacks you would be a comical genius.

I also love how in your first paragraph you are criticising me for my example of a patient put in a very unfair position (a situation which is 100% inevitable based on the new policy) on the grounds that "realistically, how often does that happen?" So the number of patients that happens to probably is rather small, so who cares? Then, at the end of your second paragraph you conclude that you have so much empathy for this poor, random person on the internet that you've never met that you genuinely hope I somehow manage to overcome my clearly deeply pathological obsession with this imagined "injustice," for otherwise I will surely die a lonely, bitter old man.

It seems my comment wasn't at all helpful. My apologies. In no way was it meant as an attack. And I don't think you're obsessed. I responded to you, a random stranger on the internet, because you asked for other people's opinions. Again, I'm sorry it wasn't useful.

[nursej22, MSN, RN]

My former employer used to fill prescriptions for patients and employees. They phased that out for all outpatients , including employees. Then, one local grocery chain and one major chain were in network. That was phased out, and the only in-network was a mail order, through the corporation, that was in another state. That's fine for long-term meds, but sucks when you need something urgently.

[Katillac, RN]

Take it in stride? Just like having to take another patient, on top of the 400 you already have. And having your schedule changed at the last minute, and like many other examples you can think of.

Taking everything in stride is why nursing is in the state it's in.

Get your back up, friend, and be part of the solution.

This board and media in general are full of stories of employers, possibly most notably or maybe just most ironically in health care, who show less an less regard for the physical, emotional and financial well being of their employees while they hey prioritize profits and satisfaction scores. Most of us can imagine the OPs facility getting one complaint about a discharging patient saying they waited too long for a script because an employee was picking up theirs and immediately the decision getting made to ban employees. I've come to expect that kind of reactionary and poorly thought through response, and I've tried to try to accept it because it's too frustrating not to.

But maybe you're right, Kooky Korky, and there's value in continuing to push back against the impossible expectations and mistreatment. Part of the solution/part of the problem and all. Thanks for your thought provoking comment.

[FolksBtrippin, BSN, RN]

Yes, I agree that your employer is acting badly on this issue.

[kbrn2002, ADN, RN]

Yes, it's messed up. The entire US Health system is somewhat messed up. For many if not most people choosing providers including pharmacies isn't a hardship if your choice is out of network. Sure you pay a little more, but the convenience is worth it. But what about those on limited incomes that take a lot of prescription meds? Then that higher out of network co-pay may make the cost of filling meds out of reach.

Even for those of us where out of network costs are not necessarily prohibitive that doesn't make it acceptable. Case in point is my insurance. My premiums took a huge jump this last year, it more than doubled. I don't live in an extremely rural area, there are 2 large health systems in our area. There are multiple pharmacies including at least one 24 hour option. And not a single one is considered in network. The small plus side is all medical providers cost the same, so there's no financial penalty for staying with your provider of choice. The only in network pharmacy is the mail order option which is ok for long term prescriptions but for an immediate need like an ABX or pain meds the only viable option is paying more for out of network. Fortunately out of network costs are't really a lot more than staying in network, but it's certainly enough more to add up after awhile. Same with dental and vision providers, we have a ton of each but not a single on is in network. The only in network vision provider closed, the only in network dental provider retired.

[martymoose, BSN, RN]

Sorry if this has been already mentioned ,most places have Walmarts . Utilize their 4 dollar prescriptions. They have a fairly big list of formulary meds.problem solved. My Walmarts here are open 24hrs a day. Doc e-scripts to them.sometimes it's cheaper than the copay I would have had at the "required "pharmacy.

We also have the option of mail order, which actually gives us a discount-for 90 day supply, only have to pay 2copays,not 3.