I'm venting some angst here because I'm fully aware how many Americans are in similar or worse situations. Frankly, I think it's criminal that in this nation, these events occur. We NEED some solutions and, no, I am not so naive as to think they will be quick and easy, but I do know if we don't wrangle them up soon, things will get even worse. We have all read the headlines about the recent tragedy of the girl that died trying to get approval for a transplant. We all know these things happen and we decry them, but they continue, rarely making headlines.
I don't know about you, but I'm pissed off about it. I'd like to relate to you a few incidents that have occurred.
I'm pissed off that paper pushers decide what health care we can receive, often with only minimal input by a physician. Insurance companies are sending patients home from hospitals to save costs, when patients are not always recovered sufficiently to be sent home. My aunt recently was one of these patients, over her physician's protests. She's elderly, lives alone, and was not even up to feeding herself yet when she was released because the insurance company decided it was time.
I'm pissed off that insurance companies sign on patients, suck them dry with high premiums, and then find a myriad of excuses not to pay for the charges. The young lady referred to above needed a transplant, which have been performed repeatedly for several years now in this nation as a fairly common practice, yet the insurance company pulled the old "experimental" clause out to avoid payment. A couple of years ago, after suffering for almost 10 years with a severe kidney problem that local doctors seemed unable to treat correctly, I went to Mayo Clinic and preauthorized the visit with my insurance. Luckily, they were able to give me some answers and recommend treatment which has greatly improved my health and, frankly, cost less then the years of inadaquate treatment I'd received until then, but my insurance company was able to find a technicality that allowed them to only pay ten percent, leaving me with over $20,000 in outstanding bills. Considering I pay premiums of $612 per month for health insurance coverage for myself (single person,) I would have hoped for a bit more help there.
I'm pissed at the hoops that these insurance companies make us jump through. In November, I had a fall and crushed three vertebrate in my spine. It wasn't a serious fall, but the injuries were. My X-rays explained why when they revealed a very advanced problem with my bones. This condition leaves me at extreme risk of fracture from falling, even getting bumped into hard. There is a treatment that will moderately reduce the risks for me, allowing me more normal activities, although it has high risks and is very expensive. My doctor and I have spent the last few weeks fighting with the insurance company trying to convince them that I do need the treatment, sending bone scans, reports, labs, etc., that show with no doubt that this woman about to turn 50 has the bones of about a 95 year old woman. Records that also show a series of fractures I've already incurred, and why they will continue and worsen. The insurance company still isn't sure I "need" the treatment. Why? Well, it means I will have to inject myself every day for two years with a combination of hormones and drugs to stimulate bone growth. It is proven to work, although it is used only in the most extreme cases. The problem is, those shots will cost about $1,5000 per month. Without the shots, I'll be crippled soon. But hey, it's $1,500 a month and my premiums are only $612 per month (of course, I have a 30% copay, but still.)
I'm pissed off that insurance companies can cherry pick their clients so that if you ever have any need for insurance, ever getting insurance again is nigh impossible. After all, they don't want to pay claims, just rake in the astronomical premiums. My cousin's son developed cancer in his last year of college. Thankfully, after a few years of treatment, he's doing well today. Of course, he cannot find an insurance company that will accept him because of the "Big C" on his record.
I'm pissed off that mental health patients are treated with such disparity. I had a family member that has suffered from mental health problems. He was seeing a therapist, but getting worse. When he was 10, hospitalization became necessary. Insurance premiums had been paid for him throughout his life. His outpatient therapy was covered 50% and only for a limited number of visits. When he was hospitalized, after a couple of weeks, a letter arrived that he had hit his life-time cap and no further coverage would be provided. He required two further years of psychiatric hospitalization, to be followed by years of out patient therapy. None of it covered by his health insurance.
I'm pissed off that insurance companies take our money when we're healthy and as soon as we need them to step up to that contractual obligation, scurry in every direction away from us to avoid doing what we trusted them to do. I don't expect them to just give away the store, but some fairness would be in order here, rather than this one-sided arrangement that serves them so well, and us so poorly.