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.