And the insurance system screws me even more

February 23, 2013

The kid tells his teacher that his book report will be late.

  • Kid: But it’s not my fault! I didn’t have enough time!
  • Teacher: You knew about this 2 months ago.
  • Kid: But the library was closed!
  • Teacher: When did you go to the library?
  • Kid: Yesterday.

You have no sympathy for the kid, right? He should have gotten the book much, much sooner. Procrastination isn’t an excuse.

Of course, what my insurance company did is even worse. You can read the basics here. After sending in the appeal, the insurance company by law has 45 days to respond. At that point, they can request an addition 45 days, which of course they did. So I counted down those 90 days, anticipating and dreading the result, but thankful that at least I’d know, one way or the other. I was glad that I could move out of limbo. I waited impatiently for my lawyer’s call. Almost a week after the deadline, I emailed my lawyer, and she responded that she hadn’t heard anything yet. So I waited more. Finally, more than a week after the deadline, I got the word: they need more time.

And this is where it gets all book report-y. They say they need more time because they need to talk to my rheumatologist. They contacted her and didn’t hear back. I asked when they contacted her. The answer: the day before the deadline. They reached out to her on day 89 of the 90 day response period. So WHY THE FUCK DID THEY WAIT SO LONG?!? Probably, because they can.

There’s nothing I can do, of course. My only recourse is to sue the insurance company, and my lawyer insists that won’t help. The company will argue before a judge that they didn’t get to speak with all of my doctors and the judge will rule that they should get that chance and in the meantime I’ll be paying the legal fees.

So I’m waiting again. I’m waiting and waiting and waiting. I did call my doctor to find out when she’ll respond to the insurance company and I am waiting to hear back from her. And that’s all I can do.

I’m furious. How can this happen? Don’t they realize there’s an actual person whose life is being affected? Who needs to make plans for the future, like whether or not she’ll be able to pay the rent next month? Who needs to know how much she can afford to spend on medical treatments? Where’s the respect for a fellow human being? Why doesn’t the patient have any rights?

I’ve said it before and I’ll say it again: when I get healthy I’m going to try, somehow, to fix this system. Because this is simply not ok.

Leave a Comment » | Educating, Expectations, Frustration, Insensitive, Politics, Rants | Permalink
Posted by chronicrants

So happy I could cry: I finally have great-seeming health insurance

November 9, 2012

I’ve long since given up on going out on a Friday night.  If there’s a special event, like a friend’s birthday, then I’ll make the effort when I can, but otherwise, I just stay in.  I hope that changes one day, but for now, paying bills is the same to me on  Friday as on a Wednesday.

So I was going through my bills and other paperwork tonight, and I came across my new health insurance handbook.  It arrived in the mail earlier this week and I hadn’t gotten to it.  Unlike most people, I actually read these things.  Plus, I went to my PCP’s office today to show them my new insurance card and arrange a referral for my rheumatologist and they said I didn’t need a referral, so I wanted to make sure for myself.

I started flipping through the handbook, figuring I’d do a thorough reading later, but then it really caught my attention.  You see, I’ve always had employer-provided HMO plans.  With these plans, PCPs (primary care physicians) must give referrals for all specialists, and I pay premiums and co-pays for everything.  I’ve been lucky to have plans that didn’t have deductibles or co-insurance.  It was a very restrictive system, but it was the only one I knew.

That’s why I was shocked to find out about my new plan!  Now, I haven’t used any of these services yet, so I can’t be sure if they’ll work out the way they’re supposed to.  And I don’t know how long I’ll have this plan.  For one thing, I appealed my denial of medicaid, so I could end up with that instead of this.  And of course that doesn’t compare to the uncertainty of the long term disability insurance mess.  If I get the insurance coverage when we appeal, then I’ll get my old health insurance back.  I’d rather keep this new insurance, I think, but I definitely need to win that appeal so that I have an income.

I was accepted for this new plan despite my pre-existing health problems because Massachusetts rocks, and it was given to me without having to pay premiums because I have no income and Massachusetts rocks some more.  Believe me, I know how lucky I am!  But I was still shocked to read the details of this plan.  I can see specialists WITHOUT A REFERRAL!!!!  I feel like I’m dreaming.  This means that I don’t have to worry about whether or not my PCP agrees with my decision to see a certain doctor!  My big issue now is that I need to find a new endocrinologist, since my last one dumped me for being the cause of too much paperwork and too many expensive tests.  I’ve been worried about finding someone who practices what I think is best approach based on the research I’ve done.  Then, once I find them, my PCP would have to approve…. but not anymore!  I figure if I can see someone soon, then even when/if I get my old insurance back, my PCP would be more likely to go along with it because I’d already have seen the new doc (or she’d be pissed, in which case I’d find a new PCP.)

Even more amazing, there are no co-pays for visits, and the co-pays for meds are incredibly low.  Now again, this is a plan for people who have no income, so I know this isn’t what everyone gets.  Still, it’s amazing to me that they did it right!  They are offering free coverage to people who can’t afford to pay, so that we don’t get really sick and end up costing even more money to them later.

It’s amazing, almost unheard of, but I think I’ve finally encountered a health-related, government-related system that isn’t broken!  I sure hope it turns out to be as good as it seems, because right now, it seems too good to be true.

I’m sure all of you readers in other countries are wondering what all the fuss is about.  I just can’t even tell you.  Click on the “Healthcare” category in the sidebar on the right (you might have to scroll up or down) and you’ll start to understand just a little bit.  It’s really lousy here in the U.S when it comes to health insurance.  Most of it is linked to employers, and many people choose jobs based less on their passions, the work, or the job potential than on the health insurance that’s provided.  I really hope this ray of sunshine lasts for me, and that the new Affordable Care Act helps things!

6 Comments | Educating, Expectations, Healthcare, Medication, Politics, Raves, Support, Unpredictable | Permalink
Posted by chronicrants

Breathing a sigh of relief: we had the sense to re-elect Obama

November 7, 2012

I was worried last night that Mitt Romney could be elected president.  Actually, it was more like scared.  Well, to be honest, I was absolutely fucking terrified!

A few days ago I wrote about Romney’s lack of compassion when it comes to providing healthcare for the non-millionaire sick people in this country.  You see, unlike every other industrialized country, the United States does not have universal health insurance.  Incredible, right?  I had planned to write about some of his other stances that could affect us, but I didn’t feel well for several days and wasn’t able to write.  I didn’t feel better until this evening, and by then I had already reveled in the wonderful news: President Barak Obama was re-elected!

My joy at this news might offend some people and that’s fine.  You have your opinions and I have mine.  But since this is my blog, I’m expressing mine.  😉

There are so many ways that last night’s election was a good thing, but let me list just a few here, in no particular order, including some great health-related results:

  1. While there is still racism in this country, it isn’t enough to stop Obama’s election or his re-election.
  2. There are now a record number of women in Congress.  We are still incredibly under-represented, but we’re moving in the right direction.
  3. There is still misogyny and and sexism in this country, but the worst offenders, those who suggested that there is such a thing as “rape that is not forcible” and that “rape is a form of conception,” were voted out of office.
  4. The Affordable Care Act will not be repealed.  I didn’t think it would be anyway, but at least now we don’t have to watch our government waste time and money with the attempt.
  5. Three states voted to legalize marriage equality and one state voted against a ban of marriage equality.  This is the first time that marriage equality has won at the polls and it happened in FOUR states!
  6. My own state elected a smart, sensible, honest woman to the senate.
  7. With the ACA safe, women with health insurance will still be able to get free birth control.  Now we need to make this happen for the women without health insurance!
  8. With Obama in the oval office, I feel much better about who will next be appointed to the Supreme Court.
  9. It is less likely now that Roe v. Wade will be over-turned.
  10. My state and others passed medical marijuana laws.  Finally, there will be a treatment without the horrible side effects of so many (all?) of the others!
  11. My faith in the American people has been generally reaffirmed.  Yes, there was the riot on a college campus last night.  Yes, there were racist comments being made.  But overall, the American people showed themselves to have, in my opinion, good judgement.  Overall they were not racist or sexist or homophobic.  Overall they voted for the good of the nation, not only for the good of themselves.  And now I can breathe a bit easier because of it.

I could go on and on.  There was the first Hindu woman elected to Congress.  And the first openly bisexual woman.  And so many others.  But in the end, the important thing is that I feel our country is moving in a great direction.  I can hardly wait to see what happens next.

3 Comments | Decisions, Expectations, Healthcare, Medication, Politics, Raves, Relationships: Family & Friends & Dating & Sex | Permalink
Posted by chronicrants

Where’s the compassion, Mitt?

November 3, 2012

There are many issues I care about in the upcoming election.  I care about the economy, health, women’s rights, foreign policy, and so many other topics, but I will try to contain my opinions and focus on healthcare here.

Last night I was watching an interesting show that did a small biography of Barak Obama and of Mitt Romney.  It covered their childhoods, educations, marriages, entrances into politics, etc.  I was half watching while I played backgammon on my phone (so addicting!) and then something caught my complete attention: there was a clip of Ann Romney, Mitt’s wife, talking about how scared she was when she first got “sick.”  She talked about being so fatigued that she couldn’t get out of bed.  One of her sons talked about how difficult it was.  She was then diagnosed with multiple sclerosis.  Around this time, Mitt was thinking about heading out to Salt Lake City to take over the Olympics.  Apparently he offered not to do it, so they could stay home in Massachusetts near her doctors, but she insisted that he do it.

I was furious.  This man has vowed not only to repeal the Affordable Care Act if he is elected, but to make it his top priority.  I understand that he wants government to be smaller (though really, if everything is handed off to the states, then what’s the point of keeping the states united?) but has he thought at all about the individuals who are affected?

I want to talk to Mitt Romney and get him to really consider how different his life could have been.  What would have happened if they didn’t come from wealth?  What if they didn’t have many many millions in the bank?  What if Mitt had to quit his job to stay home and take care of his ill wife when she couldn’t get out of bed?  What if that meant they had no income?  What if they had no health insurance?  How would she have been diagnosed?  What if they had no savings, and had to rack up medical bills to pay for her testing?  What if they couldn’t afford treatments?  Instead of deciding whether or not to organize the Olympics, Mitt could have had to quit his job and drain their savings to take care of Ann, with no money to pay for treatments, no idea when he might be able to return to work, and certainly no therapeutic horseback riding for her.  That’s what could have, and likely would have, happened to Mitt and Ann if they had not had millions.  So what does he expect everyone else, everyone without a fortune in the bank, to do?  As far as I can tell, he hasn’t given it any thought.  I wish he’d prove me wrong.

So far, his answer is simple: it’s not his problem.  Sick people should get help from their states, but the federal government won’t force the states to help, so people might just be shit out of luck.

I am incredibly lucky.  I am lucky because I live in a state where I am eligible for medicaid.  I happen to live in the state where Mitt Romney implemented a requirement that everyone have health insurance.  I live in a state where I can get at least a part of the help that I need.  Too bad Mitt Romney doesn’t realize that people outside of Massachusetts need the same services just as much, and that this unequal system is not in any way good for the country.  If only he could understand how the rest of the country lives.

9 Comments | Educating, Frustration, Healthcare, Politics, Rants | Permalink
Posted by chronicrants

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