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Our "uniquely American" health system, revisited

vastleft's picture

So, yesterday I used up my last dose of a medicine that actually worked for a chronic condition. I had used it for years, with no side effects.

My insurance company up and decided that, instead, I should be a guinea pig for medicines that didn't impinge so much on its god-ordained profits.

I had my first dose today and have had a splitting headache for hours. That's odd, because I almost never get headaches. But now, I have a whole new body chemistry! Yay!

I called the specialist who had prescribed the original medication (and whose arm had been twisted into changing my 'script). The nurse I spoke with commiserated with me about her own run-ins with her insurance (she has the same condition), and she said she'd been prescribed the new medication I was given, and it hadn't worked for her. That's a swell endorsement!

Anyway, she told me I had to contact my primary-care doctor to get "pre-authorized" (after several years of taking it -- is this a fantastic topsy-turvy world, or what?) to use the medicine that worked and didn't make me feel like I'm being beaten with a hardbound copy of HR3200. They, in turn, said the doctor would send a letter to my insurance company, and eventually I'd get a letter back from them.

So, as of tomorrow, my condition will go untreated. Only a purist would want great companies like that to be put out of business!

Maybe my insurer can scrape together a few bucks (the premiums surely have already been spent on important vacation houses and stuff) that will allow them to allow me to use the medicine my doctor had recklessly prescribed for my condition without regard to the needs of Big Insurance.

It won't be a moment too soon when millions of Americans become mandated to do business with these health-giving folks!

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Submitted by jawbone on

branch, subsidiary, or hired denier of care to determine whether my insurance and condition (cancer) warranted the yearly whole body scan I must have -- and have had since my cancer was found. I will need to have such a scan annually until my scan is clear, and, since there are some remnant tissues left, it will not be clear until/unless I have a treatment level of the radioactive iodine -- which, given its negative effect on my salivary glands, the docs are currently saying to not do.

Wait and see.

Protocol for this cancer is to have annual scans for 5 years, then biannual for some additional years, then every third year -- I'm in year three. But, apparently, the BIP is looking to cut some costs by cutting some care. Whodathunkit?

However, given the situation VL is in, where a chronic condition will go untreated for some undetermined amount of time when an effective remedy is known and has been used successfully by this individual patient?

Time to write your rep and senators, along with the WH and Obama. Time to share your story with some editorial page editors (LTEs).

Time to sue for pain and suffering?

This is completely disgusting behavior by this BIP.

*BIP--Big Insurance Parasite

Submitted by regulararmyfool on

People dying in the great wasteland of America. No moral, no ethics, no leaders, just stumbling around in a circle, but their god of Mammon must be appeased with human sacrifices. So the rich will still have money.

gormenghast's picture
Submitted by gormenghast on

to make changes to their formularies at any time, but are supposed to notify you and allow you one month's supply of your current drug in order to give your medical provider the opportunity to "pre-authorize" your access to said drug. Your doctor cannot simply write a letter saying "I'm the doctor by god, and I want the patient to have this drug". No, he must provide evidence that he has "stepped" you. Stepped means that he/she has tried you on "approved" A, B and C drugs to little or bad results first. Now, A and C may no longer be on the formulary, so they don't count, so he/she has to find out what approved drugs are on the formulary so that he/she can say that they have been tried and if that is true, or he/she will say it is true, then it will go to the Pre-Authorization department. If the PA department can't sort it, say because your diagnosis does not fit neatly into what the insurance company says the drug can be used for, albeit that it works for what ails you, the application goes to the in-house pharmacist. The in-house pharmacist (average salary $90,000 per annum) will make the final decision based on following company guidelines and keeping his/her job. If the decision is that you get the drug, then said drug will be approved for you as "off formulary", moved to class 3 and if your co-pay was $25.00, it will now be $60.00 or more. If the drug is not approved, then you will be properly stepped with the ineffective, approved drugs before your pre-authorization can be reconsidered. After you have been stepped, the drug will still be off formulary and the co-pay will still be increased. It sucks and I am so sorry.

Signed Anguished in the PA Department - United Health Insurance Inc

Submitted by gob on

for naming names and giving details. You do mean to say you work for these people in the Pre-Auth department, yes?

Be careful!

Submitted by lambert on

So who's your boss? Swelter? ;-)

And I'm glad you felt you could post here. Thanks!

koshembos's picture
Submitted by koshembos on

I had a lousy insurance day today. I went for an acupuncture session out of desperation with regular medical procedures. Well, my employer doesn't cover acupuncture; the Government, quite conservative provider, covers acupuncture similarly to other procedures. My employer has many thousands of employees. Acupuncture is treated by the National Institute of Health (NIH) as a legitimate medical school. My employer gives me the finger.

Then, my doc prescribes for me the last several years a vitamin used as a drug. It's about $20 a month. Some insurance companies cover what vitamin whose use is enhancing some enzyme. My employer doesn't.

That's not the end of the list, although the first item cost me almost $400.

Submitted by jawbone on

insurer has decided he does not need to have the ablation treatment dose of radioactive iodine. He was tested for a blood marker while stimulated (with thyroid stimulating engineered hormone shots) and did not have a high count for that marker, so now the insurer is saying he's "clear" and doesn't need to treatment.

The ablation treatment is to try to kill off any remaining thyroid cells, which may or may not be cancerous, which may be anywhere in the body but especially in the thyroid bed and neck area. It is literally impossible for a surgeon to remove every remnant of thyroid tissue during surgery as that would mean deeply invasive and dangerous digging around to try to find all the tendrils of thyroid. That is the reason that the surgery for removing a cancerous thyroid is always followed by radioactive iodine in much higher doses than used for a whole body scan.

But the insurer is not only saying no to the ablation, it is saying no to the necessary annual whole body scans. The first doctor did not fight for his patient; a second doctor is aghast at this malpractice by the insurer--but can't get them to budge.

I get the feeling our dear avaricious BIPs (Big Insurance Parasites) are doing lots of preventive denial of care to ensure their continued profitability and maybe build up sizable nest eggs in case there is real health care reform.

With Medicare for a robust private option. (Thank you, Sen. Baucus, for doing the dirty work for Obama and Rahm....)

*This lack of follow-up is particularly egregious as the patient is male, and, statistically, while fewer men get thyroid cancer, their mortality rate is higher.