Insurance Hell . . . As if Being Sick Isn’t Bad Enough

pillsI’m not one to air my feelings about government intervention (except in my novels, of course) but this whole thing about forcing United States citizens to buy health insurance is about as insane an idea as . . . well, as aspartame, and that got shoved down our throats, too.

The main problem with our health care system is the insurance racket, and the government wants to reward them for stupidity with our money? Sheesh. Case in point:

I am taking care of my 96-year-old father, and he’s recently taken a turn for the worse. He was in the hospital for pneumonia and various tests for about a week. Got out about eight days ago. The doctor prescribed a breathing treatment, but when I went to pick up the drugs at the pharmacy that night, they weren’t ready. Somehow, the doctor had forgotten to send in the prescriptions. Several calls and one personal visit to the doctor’s office later, the prescriptions were called in, and that’s when the fun really started.

The insurance refused to pay for the breathing treatment, so the doctor changed to a different one — one, moreover that the insurance company said was covered. I went to pick up the prescription and again, it wasn’t ready. Turns out this particular drug needed a doctor’s authorization. Say, what? Isn’t a prescription an authorization? Apparently not. Apparently, the insurance company wanted the specific reason why the doctor had prescribed that particular treatment. So I started making calls again, to the doctor’s office, trying to get them to do the authorization; to the pharmacy, trying to get them to do their part. Finally, the authorization was sent. But . . .

The insurance company told the pharmacy to bill Medicare, that they don’t handle any aerosol treatments. Huh? So what was the whole thing about changing medications to one that the insurance company does cover? Anyway, Medicare agreed to pay for the drug but . . .

Yep, another but. As of this year, Medicare has a $148 dollar per year deductable, which means my father ended up paying the whole bill of $119.00 out of pocket. He pays a fortune in insurance, a fortune in co-pays though his insurance policy, and yet because the insurance company refused to honor the prescription, he ended up bearing the full cost. A refill, of course, will be only thirty dollars or so, but the problem is that this replacement drug needs to be taken four times a day, every six hours, instead of two like the originally prescribed drug. It will be hard getting my father to do the treatment even once, so we will have a year’s supply of the drug, which means that any refills will also be at full cost.

So, if he has to pay the entire cost of the drug out of his own pocket, why weren’t we told this upfront so we could have just gotten the original prescription and been done with it?

This sort of situation is becoming way too common. I have a friend who suffers from advanced rheumatoid arthritis. One particular very expensive injection is keeping the disease at bay, allowing her to continue living without too much debilitation, and yet her insurance company refuses to pay for the shots any longer. The drug company ended up finding a sponsor for her. So what’s the point of having insurance if you have to beg someone to pay for a drug you need to survive?

And this is the insurance hell that everyone is going to be forced to endure. Cripes. As if being sick isn’t bad enough.

***

Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+

10 Responses to “Insurance Hell . . . As if Being Sick Isn’t Bad Enough”

  1. mlfhunt Says:

    Pat, Insurance is only part of the problem. After reading this piece in last week’s Time magazine, I was shocked to see the real truth about the cost of health care…and I thought I was informed. Overcharging by hospitals is the other part of the problem.
    Check this out: Bitter Pill: Why Medical Bills Are Killing Us
    http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

    • Pat Bertram Says:

      The entire system is insane, and it’s going to get even worse. I was so proud of Jeff for staying away from doctors as long as he did, especially now that I’ve heard so many horror stories from my fellow bereft aobut how their spouses died. As horrendous as his death was, it was vastly easier than most, and that’s because he only had to deal with the illness, not mistreatment or overtreament by the medical establishment.

  2. @MedicalTraveler Says:

    I was going to link you to the “Bitter Pill” article in Time but mlfhunt beat me to it. If you want to see a distillation of some of the more head-turning facts in that 22,000 word, 36-page article: http://info.healthtravelguides.com/destination-healthcare/bid/173092/Is-American-Health-Care-Doomed

    Basically the author Brill makes the excellent point that the debate over who will pay is something of a red herring, the real issue is, of course, why we have to pay so much in the first place. It’s fairly shocking to see the deep dive into the reasons for the sky high cost of our insurance-driven system.

  3. nivaladiva Says:

    Hi, sorry to hear of your insurance woes. I am not a fan of the bureaucracy and run-around, for sure. But not all insurance carriers are the same. When my husband was sick, his insurance (Blue Cross) covered a helluva lot and his doctors knew how to maneuver the system really well. It got trickier when he went on hospice but we got around that too. I don’t see why everyone having insurance is a bad thing. Right now those of us with insurance are paying for those who don’t. Just my 2 cents.

  4. Juliet Waldron Says:

    I sympathize with your insurance troubles. Got some of my own at the moment, also re overpriced, ineffective drugs reordered inadvertantly by my Doc’s office, and for which I now have the honor to pay–even though it was not my mistake. I’m among those who believe the solution is single payer, which would cost the govt. far less money than it/and We The People spend now–i.e. do what the Europeans, Canadians and others have opted for, instead of wringing the last dollar out of ordinary folks via insurance companies and big pharma. We would have to ration services and queue as they do for elective surgery, as they do, but, frankly, I’ve lived in the UK, and it was sure nice to be able to see a doc when you had a sore throat, or take a child for a check-up or vaccination without it costing a week’s paycheck.

  5. parlourlady Says:

    Canadian fan of your work here, and fellow author. Our health system is provincial, and each province is responsible for their residents’ health costs. I feel for the Americans, and frankly can’t figure out how you do it. I would hate paying outrageous insurance costs and worrying about mortgaging my house if we ever came down with health issues. In fact, we really wanted to retire down in the States (sick of the endless winters here) but frankly, we don’t want to lose our health care. It’s a deciding factor of us staying here. I hope things get better for you, and I hope someday you opt for a Universal health care system. I can assure you, the horror stories you hear down there are simply untrue. We have a great system here, as well as the UK, France, and most developed and even some third-world countries.

  6. ROD MARSDEN Says:

    I sympathise. Insurance companies are the same the wotld over. They are there to make money and not fork it over. With my health insurance there are these ‘gaps’ that I have to pay fior dental, ect. Why gaps? You got me. I have a feeling I am supporting them and not getting much in return.

    • Pat Bertram Says:

      Insurance is a racket. If the medical profession could make payments for services rendered affordable and payable in installments, we could do away with insurance companies, but that will never happen.

  7. Shawn Says:

    I take a medication that without insurance costs about $125 for a 10ml vial. With insurance it’s $150…. The insurance says that it would be $250 without them. I called and questioned them about this and the guy got nervous. They are criminals. We are being forced to deal with criminals. The money would be better used regulating these companies and maybe give people the option to order from Canada. But the pharmaceutical companies have too much influence on our government, just like every other business that puts the screws to the people on a regular basis.


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