My son goes to the doctor every three months. My husband’s company doesn’t provide health insurance, and I am self-employed, so we go to the marketplace for our insurance. We’re on that edge between Medicaid and making too much for it, so we use our subsidy and try to find something that will cover our son’s needs and not break us too badly. We’re in Michigan, so we ended up with Priority Health, and it’s been an experience.
We spent two hours in November on the phone with the Marketplace discussing the plan we ended up with, making sure it covered his doctor, his nurse practitioner, his medicine, the entire practice he visits. We tried to cover every conceivable angle they might use to try and deny us access to our coverage.
It didn’t work, by the way. We still have to fight every three months to get it covered because despite their own literature saying they covered one particular person, they are saying it isn’t actually covered and we need to pay 80% OOP. The first time, my husband called them and told them that what they were doing was actually in violation of their agreement with the Marketplace.
They thanked him for calling and hung up on him.
Since then, I’ve blasted every bill out on social media. It seems to get their attention much faster, and they will actually talk to us about the problem. It’s not fixed, and it’s a quarterly fight, but we got their attention. My husband and I don’t even have doctors of our own because we can’t really afford to take on our own medical problems while we’re fighting for our son.
There are so many people with similar stories out there.
People who have discovered they can't get the only medication that works for their disease because the insurance company deemed it unnecessary. People who have to leave a medical team they feel comfortable with because the insurance company stopped covering them or their employer changed insurance providers. People who were denied rehabilitation services because the insurance company decided they were capable of doing it on their own.
And then there is this guy's truly horrific story. His 29 year old son drove his truck into the river and killed himself because he couldn’t afford his meds without insurance, and his insurance wasn’t going to start again for a month.
And, as if to prove that "death panels" are already in place, the insurance company has a most tasteless response.
This guy handled the form tweet much better than I would have.
But when people wonder why Single Payer is the hill I will die on, it's because people are already dying for the insurance companies' bottom lines, and I won't have my child be a profit margin. I have friends with horror stories of their own. Two of them had their insurance companies drop their doctors without warning, one had a medically fragile child with a team she trusted and who were helping her child thrive. She lost access to that team. One of my friends discovered that the insurance company refused to support her insulin pump for her T1 diabetes, even though that pump was the only thing that had worked at keeping her blood sugars level. Another friend’s child was taken off of his diabetes medication because the insurance company would only cover another brand that didn’t work as well.
With all these horror stories, how can people say we just need to fix the ACA? That doesn’t fix the problems in a for-profit system. It doesn’t give all these people “access” to their basic right to life. And, as we can see, this profit driven system is TRULY killing people.