You're not crazy.
If you wonder why you pay huge monthly premiums and then have to fight to see a doctor, plead to get a test or fill a prescription let me assure you, you're not imagining a damn thing.
Your health insurance is only worth the amount of time and effort you are prepared to fight the insurance company to collect anything.
Many Americans just throw in the towel. Insurance companies are counting on you to do just this. Give up. Walk away.
Many Americans still refuse to recognize that the insurance industry just wants you to go away and die. But first they want you to pay them lots of money in the form of ever increasing premiums, higher co-pays, and huge deductibles.
And keep in mind, Mr. Bush wants to sucker you into getting your health care in a Payless, Savon or Rite Aid drugstore. This is how little the Bush crowd thinks of you and me. They believe Americans should receive their health care in cut-rate pharmacies.
Or better yet, they'd like to entice you into buying a piece of shit Health savings Account (HSA) which these lying bastards call consumer directed health care. In this scheme, you'll pay for your treatment with your very own HSA and in theory shop around for the cheapest doctor and the cheapest hospital--and you'll do this while bleeding to death or having a heart attack.
But in truth, we Americans have been suckered into one of the biggest and most deadly scams ever inflicted on a group of good, honest, hard working, tax paying citizens. We pay for insurance, we believe if we need medical care, the insurance company will treat us with some measure of integrity. But this is no longer true.
Some of you may have read the diary I wrote a few days ago about the patient of my friend the surgeon and oncologist: Looking into the eyes of a dying woman. You can read it here if you'd like:
http://www.dailykos.com/...
Then I described a situation involving an expensive cancer drug called Avastin. This drug costs around $2200 a month.
The woman whom I met this afternoon, is a patient of my friend the surgeon and oncologist. This good doctor wanted me to meet her and her family because like so many millions of Americans they have been forced into a demeaning and ultimately fruitless battle with her insurance company.
. . .Sarah was prescribed a course of Avastin to help shrink her tumors. From what I gather Avastin is used primarily for colon cancer. It's use for other cancers is still somewhat experimental. Though only yesterday the FDA expanded the label for it. You can read the story here:
http://www.marketwatch.com/....
Miraculously the Avastin started to work almost overnight. Sarah's tumors started to disappear almost before their eyes, her husband told me.
The insurance company refused to pay despite being sent documents, medical reports, lab reports all confirming the miraculous shrinkage of her tumors.
Her family pooled their resources and paid the cost of the treatment which they told me was around $2200.00 per round of chemotherapy.
But much less expensive drugs are also routinely denied. Here's what Kaiser Family Health is reporting:
The Boston Globe on Sunday examined how prescription drug formularies established by health insurers have received criticism from many doctors, who "say they are facing increasingly high hurdles in their attempts to prescribe drugs." Under formularies, health insurers cover a limited number of medications for specific conditions and may restrict the amount of medication covered monthly. Physicians in some cases can obtain "prior authorization" for medications not included in formularies, "but doctors and patients say winning prior authorization is complicated and time-consuming," the Globe reports.
http://www.kaisernetwork.org/...
Now the insurance company will even fight you on a God damn, fucking $40.00 pain patch.
The stabbing pains struck her left leg, shot up her hip, and flared into her back. They became so severe that Patricia Rodrigues , who has a rare genetic disorder called mitochondrial myopathy, sometimes screamed in agony.
She could not get out of bed into her wheelchair, never mind drive her minivan equipped with hand controls. Twice in recent weeks her daytime care assistant became so alarmed that she had Rodrigues taken by ambulance to a hospital emergency room.
Worst of all, her intense suffering could have been prevented. Rodrigues's doctor said her insurance company covered the cost of pain pills, which were ineffective, but denied his request to give her a $40 skin patch filled with a powerful narcotic called fentanyl.
http://www.boston.com/...
The insurance companies feel free to deny common medications:
Eli Medwar , a retired Sharon accountant, said that when his prescription for the reflux disease medication Protonix was reduced from two pills to one pill a day by Blue MedicareRx, a national Medicare prescription plan , he suffered heartburn. After his doctor's appeals to the insurer were denied, Medwar complained to his congressman, Representative Barney Frank , whose office contacted Blue MedicareRx and was able to secure Medwar's twice-daily dose.
It's simply unbelievable how broken the system is:
Her case is a dramatic example of how insurance company restrictions on prescription drug coverage can affect patients. Many doctors say they are facing increasingly high hurdles in their attempts to prescribe drugs, even those that treat common maladies like heartburn and migraine headaches.
And it gets worse. Even some Republicans (can anyone say Election day?) are voicing concern about independent pharmacists not being paid in a timely fashion when they fill Medicare D prescriptions.
The Bush administration has rejected calls by Republican lawmakers to intercede on behalf of small pharmacies engaged in a payment dispute with Medicare's new prescription-drug plans.
The agency that operates Medicare will not consider a recommendation by 41 House Republicans that it enact new requirements for how fast prescription-drug insurers pay pharmacies, a senior Medicare official said.
http://thehill.com/...
But Bushco doesn't give a rat's ass. Guess these independent pharmacists haven't paid big enough bribes to the Rove/Delay/Frist/Boehner/RNC/K Street cabal of thugs.
Independent pharmacists have been griping to Congress about long waits for payments from the companies that administer the drug program, Medicare Part D.
The small pharmacies are locked in a David-and-Goliath battle with the well-heeled and influential pharmacy-benefit managers (PBMs), which are represented by the Pharmaceutical Care Management Association (PCMA).
The Association of Community Pharmacists Congressional Network (ACPCN) has engineered an aggressive grassroots campaign, and the National Community Pharmacists Association has lobbied the Hill on the payments.
. . .But the administration is wary of stepping in. "We would feel hard-pressed to come in and dictate what exactly the terms should be" in the contracts between the PBMs and the pharmacies, said Larry Kocot, a senior adviser to Mark McClellan, administrator of the Centers for Medicare and Medicaid Services (CMS), which oversees the health programs.
But all is good in the land since we're bringing Democracy to Iraq. And we're also winning.
