Health Care Hijinx

It's gotten so absurdly ridiculous that I finally can't keep silent any longer. I've felt a rant coming on for quite some time, and now I just have to let it out. Health care and the insurance industry are tying the hands of our doctors and crippling the wallets of ordinary Americans, who are just trying to get by and stay healthy.

The first incident that led me to this point happened about five years ago. Jake had hideous headaches for over a year and nothing any of the doctors tried made a difference. Not only did he have full-blown puke and miss school migraines, but also daily, crippling “normal” headaches. The pediatric neurologist where we finally ended up ordered an MRI of his brain. He was eight. I can't remember which insurance we were with at the time, because it's all just a blur of new company every August, higher premiums, lower coverage, higher you-pays, and less choice in doctors and facilities.

This MRI was at Children's Hospital. An in-network facility. That didn't stop them from denying our claim. Apparently “elective” MRIs aren't covered until you meet your (sky-high) deductible. Do you think I'm taking my kid's headaches casually, and have ELECTED to have this procedure? I'll do anything to find what's causing his pain. His doctor said this would help. I'm doing it. No “election” necessary, but that's beside the point. That kind of insurance crap I'm used to. What really pissed me off was Children's policy. If you DON'T have insurance, they discount the procedure 20%. If you HAVE insurance, it's full price. In other words, I HAD INSURANCE, never mind that it wasn't covered, I paid full price. Out of my pocket. You know what a brain MRI cost in 2005? $1843.78. They “kindly” let us pay it in installments. $75 dollars at a time. I'm still furious. Thank God his test came back normal, but it took me weeks to get that report out of them. I think for that price they should have framed it in gold and hand-delivered it to me.

Last year was a really “great” year for insurance in our family. We were on three different policies. It's not just the hassle of all that paperwork. “Please list all your past surgeries, with date, doctor, facility, and diagnosis.” I have had the misfortune of needing 14 surgeries. They never give you more than three tiny lines to answer that. More significantly though, these frequent changes meant that we had to start paying our deductible over again THREE times. Never did meet it on any of the plans.

Of course, this August when the insurance changes came out, I was reluctant to see what the new “fabulous deal” was. Hmmm, completely new company, new type of plan, new mail order pharmacy, maybe this time we'd be OK. I never should have let that thought enter my brain. They've already shown their complete and total lack of common sense on two different occasions.

The first idiotic incident happened with my chronic pain doctor. I've been on the same drug, same dosage, for four years now. This new company filled it fine the first two months, then denied it the third month “at this dosage”. I took their lovely form letter to my dear doctor who said, “Yea, we've been getting these a lot this last month. Election coming up. Everyone getting their ducks in a row in case something big happens. I know just what to do. It's the NUMBER of pills they're objecting to. I'll just make it for fewer pills by doubling your dose.” I was incredulous. I used get four 10 mg pills, and could take one or two, twice a day, depending on my level of pain that day. Four pills a day. They took this choice away from me. Now I have two 20 mg pills per day. I no longer can cut the dose in half if I'm having an OK day, because this is a time-release med that you CANNOT cut or it releases way too much all at once. The insurance company is making me take MORE drugs than I need. Does this make sense to anyone?

The final event that broke my silence happened today. I'm having trouble with my hip, and the pain has been escalating over the last three months. I saw a hip specialist on Monday who ordered an MRI. Guess what they said about coverage? If I have it done IN THE DOCTOR'S OFFICE, it's covered. 100%. No co-pay, no meeting the deductible. However, if it's done in an “out-patient facility”, I have to meet my deductible first. I asked her. I clarified. “You mean, that if they use the same kind of machine, in the same kind of way, but one happens to be in an “office” and the other in a “facility”, then it's covered differently?” “Yes, that's what I'm saying.” So I of course decided a call to the “place” (since it has yet to be classified, you see, the machine belongs to my doctor's office, but is in a separate place in the building, their “MRI Suite”) and ask what category they fit in to. Of course no one could come to the phone right then, but I could leave a message...

I swear, all of this is enough to make this girl go on a search for some “medical” marijuana and just zone out and forget it all. Anyone know a good “doctor”?

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