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Posts Tagged ‘insurance companies’

Today I spent a good part of my afternoon dealing with insurance companies. It never ceases to amaze me how these huge corporations can charge exorbitant amounts of money for the privilege of insuring you, then when you actually need to use the insurance you have paid for, do everything in their power to make it difficult for you to do so. I was helping someone I care about very much traverse the deep, dark depths of our healthcare system. This person is a complete novice when it comes to being ill, and a very nice and kind human to boot. Allowing him to try to figure this out alone, would be like sending a lamb to the slaughter. The diagnosis is possible lung cancer. I told him, like a roller derby queen with rivals on her heels, you have to elbow and bully your way to the front of the line, because time, particularly with this disease is not your friend. This, I can speak to with experience. Rick also had lung cancer. It was not good to him, as emphasized by the fact he is not here to tell you his story himself.

My friend has an HMO. This supposedly means he can pick and choose from the pool of doctors within his network, rather than be limited to a certain group of physicians. So, we got some recommendations for excellent doctors in this field, and he contacted his primary care physician who in turn sent off a referral to the oncologist we had selected. As luck will have it, his insurance card listed a particular county under the primary physicians name which is the county next to mine. The oncologist he chose is situated in my county. This completely threw a monkey wrench into an already unbelievably red tape bound system, and the wheels of progress came to a loud and grinding halt. I spoke to three different representatives, each one providing us with varying interpretations of his coverage. Now, there is fluid building up on the outside of this man’s lungs while all this is transpiring, a situation destined only to get worse not improve as time marches on. Phone calls are going back and forth and the clock is ticking. Finally, a healthcare representative got on the phone with the oncologist’s insurance person and some sanity returned where lunacy had reigned supreme. Good Lord. Still, we were informed an authorization had to go through the big machine and be approved first prior to seeing the oncologist he had chosen. Okay, let’s do it. This, the rep said, takes 3-4 days. Once that is done, then an assessment is done at the physician level to determine the urgency of the situation. Now, I didn’t go to school for twelve years, I don’t wear a white coat nor do I dangle a stethoscope around my neck, but even I can pretty much predict the outcome to that one. It was urgent two weeks ago. Sigh. A whole other question lingering in the background is how, when under a physician’s care for heart issues the past year, did one of those doctors not hear the sounds in this man’s lungs with an instrument in their ears? Particularly, when I could hear the congestion while standing next to him. Many times as we get older, our complaints are written off as hypochondriacal, or lumped under the “it comes with getting older” umbrella. This too, needs to be looked at under a magnifying glass. For years if I complained about not feeling well it was dismissed as women problems. Right. I am missing two non-essential parts due to doctors waiting too long to diagnose a situation.

No sooner had we put the wheels in motion to get this approval going, another phone call came in telling us it couldn’t be done. It seems in the insurance company the right hand didn’t know what the left was doing and we had been given the wrong information. In the state of California our insurance is divided up into sections. In order to go to a doctor, even under an HMO, the doctor must be located in the section you reside in. We could have used my address but as we’d already explained the situation to several people that train had already left the station. So, back to square one, we began the referral loop for an oncologist in his area. This has been processed, thankfully, and an appointment is on the books for he end of next week. I pushed for sooner, but it seems there are a lot of people dealing with cancer at the moment, so we wait. In the mean time, if his situation goes from tolerable to not, he must go to the ER immediately. I am exhausted, but this is nothing compared to how frightened and unsettled my friend must be feeling as he is the one with the ticking time bomb inside his body.

Hopefully, one of these days we’ll actually get elected officials willing to step up and do something about the exorbitant drug costs as well as the broken insurance situation in this country. It is difficult to get them motivated in the current your side and my side mindset existing in our legislature. To add to that, the people in congress have their healthcare paid for so they aren’t really pushed against the wall on their end to do anything about it. Perhaps that should change?

Anyhow, for this day we have put out the fire. I’m sure many others will pop up along the path but I feel some advancement has been made. Truly you have to be your own advocate if you wish to have the end result you are looking for when dealing with a medical condition. Never be afraid to say you don’t agree or fight for what you know needs to be done and where you need to be seen.

My vent for a Thursday. Have a great day. Stay healthy.

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