Ok so, just another example in endless examples of how our insurance system is so utterly screwed up.
I have an insurance company that isn't all that United, nor do I believe they are Americans <img src="i/expressions/face-icon-small-smile.gif" border="0"> as a primary insurance, it is my parents and i'm the dependent on it. I have been on it for a long time. All the companies are basically all the same, because their main purpose (like we discussed in the other political thread) is to keep profits up...And they do that via denying service/causing so much stress, people sometimes just give up due to the mountain of bureaucracy. I am also on a Medicare plan that doesn't seem to allow too much Freedom <img src="i/expressions/face-icon-small-smile.gif" border="0">.
So I had my last sinus CT scan maybe around August or September, and I had a CT (maybe it was an MRI, doesn't really matter in this story) done earlier in the year on my chest...This was when I was having very bad hemoptysis and they were trying to figure out what was causing it, hence the need to have scans done of the two areas (maybe they could have done both with one scan, but at the time they weren't sure what was going on so who knows).
So my doc talked to me about lowering my resolution against doing things that are very invasive, and to finally bow down to sinus surgery. I agreed. He ordered me a last CT scan for my ENT doc to go by for the surgery. That was the start of endless hoops to jump through.
Apparently, what my doctor wants to do is not as important or valued as what my insurance wants to save money on not doing. Both my doc and the imaging center where I had set up an appointment a month or more ago have been going back and forth with my insurance company (the not so United Americans). Today was basically the last day I would be able to do the CT scan, and "stat" the films over to my ENT for evaluation, before the surgery...Because my ENT doc is going on vacation for 2-3 weeks soon after.
I called my liaison at the imaging center again today to confirm my appointment in 30 mins, she again called my CF doc, and then the primary insurance..."They were still going over the paper work, and would get back with them when they could if they determine to cover the procedure".
So essentially, due to time scale, I was denied through my primary insurance...Even if they eventually say yes (doubtful at this point), I have to put off sinus surgery for another two months or more maybe, meanwhile I sit around and suffer with a waterfall of sinus goo running down the back of my throat and settling into my lungs overnight, and contributing to my overall problems.
So I say "I know, let me try and use my awesome Medicare secondary insurance that I pay over 100 bucks into monthly, and have used ONE TIME for a clinic appointment in over a year and a half". I call up my rep at the imaging place, and give her my info. She tells me they shouldn't need a referral (WOW some good news!). So she calls them, and calls me back and says "Well the management down there said that if your primary insurance denies you, they will also deny you. If they accept it, the most we will pay is the copay".
Like I said, I have paid into my own Medicare policy @ more than $100 a month for like a year and a half. I've never used them for medication because they revert to Medicare rules regarding inhaled medications (what most of mine are), where Medicare picks up 80% of the tab, you have to pay the other 20% (and with pulmozyme running 3000+ dollars, that is just impossible to pay).
My parents primary insurance sucks a TON of money out of her paychecks, just so I can have coverage/medicine, etc. She pays a colossal amount into it. Also remember, i'm probably one of the cheapest CF patients to cover, because I rarely go into the hospital or go on home IV's. The last time I was admitted was nearly 3 years ago, and before that, it was nearly 7 years.
Our current profit based insurance system generally works fine for healthy people...Who occasionally need a prescription, or a clinic visit. But if you have a chronic illness, or a dependent has one, welcome to the world of complete asshattery!
We need a system that either leaves our current system intact, and 100% takes care of people with chronic/catastrophic conditions/diseases and we pay a reasonable amount into every month based on ones income...
Or we need responsible universal coverage in which EVERYONE pays into at a reasonable amount and everyone is covered 100%, regardless of their condition/needs. We are the greatest country on Earth. We have robots crawling around on another world collecting all kinds of data for future terraforming/bases. We we the first to manipulate the atom for energy and destruction more than 60 years ago. We can manipulate atoms individually to create nano structures and functioning machines. We create quad based CPU's that function way over 4 billion operations per second.....
BUT WE CAN'T HAVE PROPER, RESPONSIBLE, NEED BASED HEALTH CARE FOR OUR CITIZENS!?!?!?
I am not pretending to be a martyr here...My current problem is small in comparison to the constant real tragedies we see from parents who have infants die due to procedures denied, adults conditions worsen and die/lose more quality of life...And I love my country. But it's obvious greed like this that makes me ashamed of my country. I'm sure the right leaning types won't like this post, and will flame me, but if you think our system is just peachy keen in it's current state, sorry, your head is screwed on wrong.
I have an insurance company that isn't all that United, nor do I believe they are Americans <img src="i/expressions/face-icon-small-smile.gif" border="0"> as a primary insurance, it is my parents and i'm the dependent on it. I have been on it for a long time. All the companies are basically all the same, because their main purpose (like we discussed in the other political thread) is to keep profits up...And they do that via denying service/causing so much stress, people sometimes just give up due to the mountain of bureaucracy. I am also on a Medicare plan that doesn't seem to allow too much Freedom <img src="i/expressions/face-icon-small-smile.gif" border="0">.
So I had my last sinus CT scan maybe around August or September, and I had a CT (maybe it was an MRI, doesn't really matter in this story) done earlier in the year on my chest...This was when I was having very bad hemoptysis and they were trying to figure out what was causing it, hence the need to have scans done of the two areas (maybe they could have done both with one scan, but at the time they weren't sure what was going on so who knows).
So my doc talked to me about lowering my resolution against doing things that are very invasive, and to finally bow down to sinus surgery. I agreed. He ordered me a last CT scan for my ENT doc to go by for the surgery. That was the start of endless hoops to jump through.
Apparently, what my doctor wants to do is not as important or valued as what my insurance wants to save money on not doing. Both my doc and the imaging center where I had set up an appointment a month or more ago have been going back and forth with my insurance company (the not so United Americans). Today was basically the last day I would be able to do the CT scan, and "stat" the films over to my ENT for evaluation, before the surgery...Because my ENT doc is going on vacation for 2-3 weeks soon after.
I called my liaison at the imaging center again today to confirm my appointment in 30 mins, she again called my CF doc, and then the primary insurance..."They were still going over the paper work, and would get back with them when they could if they determine to cover the procedure".
So essentially, due to time scale, I was denied through my primary insurance...Even if they eventually say yes (doubtful at this point), I have to put off sinus surgery for another two months or more maybe, meanwhile I sit around and suffer with a waterfall of sinus goo running down the back of my throat and settling into my lungs overnight, and contributing to my overall problems.
So I say "I know, let me try and use my awesome Medicare secondary insurance that I pay over 100 bucks into monthly, and have used ONE TIME for a clinic appointment in over a year and a half". I call up my rep at the imaging place, and give her my info. She tells me they shouldn't need a referral (WOW some good news!). So she calls them, and calls me back and says "Well the management down there said that if your primary insurance denies you, they will also deny you. If they accept it, the most we will pay is the copay".
Like I said, I have paid into my own Medicare policy @ more than $100 a month for like a year and a half. I've never used them for medication because they revert to Medicare rules regarding inhaled medications (what most of mine are), where Medicare picks up 80% of the tab, you have to pay the other 20% (and with pulmozyme running 3000+ dollars, that is just impossible to pay).
My parents primary insurance sucks a TON of money out of her paychecks, just so I can have coverage/medicine, etc. She pays a colossal amount into it. Also remember, i'm probably one of the cheapest CF patients to cover, because I rarely go into the hospital or go on home IV's. The last time I was admitted was nearly 3 years ago, and before that, it was nearly 7 years.
Our current profit based insurance system generally works fine for healthy people...Who occasionally need a prescription, or a clinic visit. But if you have a chronic illness, or a dependent has one, welcome to the world of complete asshattery!
We need a system that either leaves our current system intact, and 100% takes care of people with chronic/catastrophic conditions/diseases and we pay a reasonable amount into every month based on ones income...
Or we need responsible universal coverage in which EVERYONE pays into at a reasonable amount and everyone is covered 100%, regardless of their condition/needs. We are the greatest country on Earth. We have robots crawling around on another world collecting all kinds of data for future terraforming/bases. We we the first to manipulate the atom for energy and destruction more than 60 years ago. We can manipulate atoms individually to create nano structures and functioning machines. We create quad based CPU's that function way over 4 billion operations per second.....
BUT WE CAN'T HAVE PROPER, RESPONSIBLE, NEED BASED HEALTH CARE FOR OUR CITIZENS!?!?!?
I am not pretending to be a martyr here...My current problem is small in comparison to the constant real tragedies we see from parents who have infants die due to procedures denied, adults conditions worsen and die/lose more quality of life...And I love my country. But it's obvious greed like this that makes me ashamed of my country. I'm sure the right leaning types won't like this post, and will flame me, but if you think our system is just peachy keen in it's current state, sorry, your head is screwed on wrong.