health insurance

I seem immediately the hysterical woman, because I don’t know how to handle anger, and so move quite suddenly to tears. Anger becomes tears fast in me.

The first indication was that the prescription was so expensive. It was filled without question, but when my honey picked it up, it wasn’t the new annual co-pay I’d expected. It was the full commercial cost of my insulin, $630 and some change: this is what it costs for a skinny month. $630 for the base privilege of being alive, not including pump supplies or other meds. Month to month, if I can afford it now.

Not that I hadn’t noticed the change over time. I used to get four vials of insulin at a time, and always had a little extra in the fridge in case of some sort of emergency. A broken or lost vial, a bad pump or set change, perhaps more carbohydrates than usual for travel, vacation, or celebration calling for more than my typical intake.

Over the past six months I’d seen the collar being tightened. Only two vials per refill now, down to sweating and not eating at the end of the month, just to be sure to have enough to cover emergencies. I’d heard what happened with inflation of the price of the epi pen, and other medications people need just to be alive. A choke, a reeling in, a strapped posture. I managed okay, even when I was down to the day I lived on insulin fumes. No complaints, a new normal. An adjustment.

The slap of my sudden six hundred dollar price tag for those two vials, and the discovery of the letter that anonymously told me: No, I was no longer covered for that kind of insulin, only for these two other less expensive brands. It doesn’t matter how important consistency is when managing diabetes, it doesn’t matter that a switch of insulin formulation suddenly, and without testing, could send me to the very expensive emergency room. Or to her door, death’s own household.

We called our insurance and asked, What can be done? Oh, so sorry, the voice said, your previous prescription has to be “medically necessary” and “previously authorized.” What the f*ck was it before? Ten years, stable and even-keeled blood glucose, established practice with the insulin and device I've adopted at great cost. What was it before, if not medically necessary and previously authorized? Just a lark, just because I felt like it?

I wept, and my advocate navigated the automated telephone trees to help me find a solution. I sit now with my new price tag, the cost of not dying, the cost I pay before food, or shelter, or the needs and support of my loved ones. Wondering, what might be done in this month before I pay the cost of living again? Where can I get my permission slip signed? How can I bend, how can I wear this guilt of living, even as others suffer more than me?

Even in my contortions I ask: What is the shape of this helplessness? Why do I feel so powerless? How did it come to this?