If you work for a health insurance company, I am not directing this post at you, but at the healthcare industry in general, especially how health insurance companies treat us. I also blame my university's human resources department for not providing better healthcare insurance for its employees. I have had costly health issues before, but my current headache treatments have been the worst so far in dealing with my insurance company.
It began when my neurologist prescribed me Emgality and Migranal for my headaches. These are expensive drugs, and my insurance company, Cigna, denied both. My doctor appealed the decision, and they approved it. They denied Emgality because I had not tried Aimovig or Botox first. When Emglaity proved not to be effective enough, my neurologist prescribed Aimovig, but Cigna rejected that too. Again, we went through the appeal process. Aimovig did nothing, so we moved on to Botox. Also denied, again appealed. The Botox has been the most successful, but whatever the cause of my current headache is, the Botox can't handle it, just as the nerve block and steroids did not help.
I have been struggling to get an MRI scheduled to rule out a tumor or other brain disorder for the past week. My doctor scheduled my MRI at the hospital, but my insurance company called and said that it would cost me over $2600 out of pocket, and I should schedule it for a place called Open MRI because that would only cost about $700. They did not explain that open MRIs are inferior images, but that's not the worst of it. Cigna canceled my MRI at the hospital, but they screwed up rescheduling the MRI at the other place. Cigna mishandled it so badly; I ended up calling my neurologist and asking for help straightening this out. My neurologist's nurse explained that I might need a more sensitive MRI if the problem happens to be very small. It might not show up on an open MRI image. The nurse will talk to my neurologist first thing this morning and decide if I need the regular MRI or the open MRI.
The insurance company's issue isn't really about saving me money, but about saving them money. If I have the MRI at the hospital, it will cost Cigna around $2000, but if I have it at Open MRI, it will cost Cigna just $210. Yes, they may be slightly motivated by helping me, but they are pushing me to have an inferior diagnostic test because it will save money. We shouldn't have to worry so much about the cost of healthcare. Stress has such a detrimental effect on our health, and to have to worry about the costs of healthcare and can we afford the treatment we need is very stressful. It is so shameful that we are one of the most industrialized and wealthy nations, and we cannot provide affordable healthcare for our citizens. I hate that so many Americans are afraid someone will get more of something than they will. Human greed is a major problem, and people don't want to give up something, no matter how small, so someone else can live a slightly better life.
I don't get why insurance companies have the power to choose what treatment we can and cannot have for conditions, especially chronic diseases such as my migraines. The United States needs serious healthcare reform. We need to have doctors be able to prescribe treatment and have those treatments be affordable. Millions of Americans go into massive debt over healthcare costs. Nearly twenty years ago, when I worked for a bankruptcy lawyer, we had many clients who had lost their job because of health issues, and their healthcare costs had become unbearable. I would see broken people come in all the time under the weight of medical debt. We would help them file bankruptcy, back before bankruptcy "reforms" made filing much more difficult. We would see a significant difference in them before their hearing because their creditors had been under court order to cease collection attempts. If we had the chance to see them after their bankruptcy had been discharged, they were completely different people. Without the stress of debt, their health was able to improve.
I will never understand why people oppose healthcare reform. I'm not necessarily talking about socialized medicine, though I think it is needed. I just mean that doctors should not charge patients without insurance more than they charge patients with insurance because doctors negotiate with insurance companies. Many things need to be reformed if we are not going to move to universal healthcare. The state of the United States' healthcare is dire, and too many people just can't afford the healthcare they need.
I am sorry to read about these issues you are having with your insurer. The US continues to trade more equitable access for all which you typically see with a single-payer system for flexibility and choice. The ACA (a.k.a. Obamacare) was a good step in reforming the system but more obviously needs to be done. I hope you can get the treatment you need. It sounds like the appeals alone to your insurer would warrant a headache.
ReplyDeleteBosGuy, I agree that the ACA was a step int eh right direction, especially in prohibiting denial of coverage for preexisting conditions. Before the ACA, I had to pay all expenses towards my migraines out of pocket, and migraine medications are very expensive, though the cost of triptans has gone down as generics have become available. Insurers took advantage of the tax credit in the ACA though and increased premiums, making it impossible for people below a certain income criteria in states that did not expand Medicaid to be unable to get insurance because they were above the Medicaid cutoff and below the ACA's tax credit income requirement. I knew one woman in Alabama who made above just above the Medicaid level making her ineligible but did not make enough for the tax credit. BCBS, one of the few health insurers left in Alabama, wanted her to pay $900 month for insurance, that would have left this woman with only a few hundred dollars of income each month. The ACA had many advantages, but it had many problems as well. We can't allow states to get involved in expanding Medicaid.
ReplyDeleteAnd yes, the appeals process is a headache within itself.
Hi Joe ,
ReplyDeletesending you a message of empathy - hope you get relief soon .
Namaste,
"Art "
Well I'm not surprise of what you said here.
ReplyDeleteAs long as USA is still letting its citizens at the mercy of those insurance company, it'll cost you, as we say in French, the skin of your ass.
Here in province of Quebec, Canada, the universal heathcare system is taking care of us for decades.
Since 2016 where after a colonoscopy (free) I had a surgery for my colon cancer and many MRI and follow up by my surgeon and doctor for my diabetes too. NO charge there too.
For my prescription meds, for my diabetes and blood pressure, I'm on the provincial medicare.
For example, the Jardiance pills could cost me $90/ month but I pay only $30/month.
And more, what I pay for my meds or any other medical services like dentist or optometrist I add those costs to my income taxe report each years and I have some deductible to my income.
That is the kind of heathcare system that Bernie Sanders came here to investigate and would like to put in place in USA but with those insurance company lobbying, there is big money at stake in stead of the public interest.
I know how expensive all meds and healthcare is in USA for having talked about it with my two friends in Delaware.
Ken has diabetes type 2 like me and his «Jardiance» is way more expensive than what I pay for.
He «husband» Guy told me that his meds have to cost him $2800 US a year to be able to have some less expensive prices.
One of the reason I say, thank God I live in Canada
I have been in healthcare for over 20 years and understand your plight...May I suggest that your healthcare provider write a letter advocating for the closed MRI...I am sure you are aware that this is called an appeal...The letter will jump you out of the queue of those who answer the phone and provide authorizations...They will only tell you what is before them...Your appeal will go to the medical director...If you push hard enough there can even be a conversation between the medical director of Cigna and your healthcare provider...Best of luck...Feel better!!
ReplyDeleteHow about if we had a society that actually promoted health? Instead they are making money off of you because you are not well. They don't make money off of people that are well. The more sickness and illness the more money. It would be nice if the conversation about health reform included things like health clubs, gyms, fitness centers, bathhouses, pools etc....Many people do not have access to such things. And don't even get me started on all the inept doctors and quackery that they call medical care. At least that is my view from Ohio. And yes I agree with you about insurance being the ones running the show. They decide what you take, not your doctor. They are the almighty authorities when it comes to your health and well-being.
ReplyDeleteJoe I hope that things get sorted out and you are able to get the scan that you need. I agree with you that Doctors should be in charge and able to treat their patients accordingly to how they see fit, as they have a greater insight as to the patient and their issues. Health Insurance Companies shouldn't be able to dictate treatment because it saves them money or some how will benefit them vs. the patient.
ReplyDeleteMost people either don't want to fight or they give up in the process and that is something that the insurance companies count on and hope for. There are some great new drugs for the treatment of diabetes but my insurance company won't cover them. As a result I am on a drug that does work but is known to cause bladder cancer.
At the end of the day we are all just numbers to insurance companies and they want to pay as little as possible so they can make a profit. It's just business to them, until it becomes someone they know or care about - then it's a different story. Kind of like how major athletes get faster and better treatment at the hospital than us regular folks.
Good luck, I am hoping for the best for you!