Insurance Hell . . . As if Being Sick Isn’t Bad Enough

I’m not one to air my feelings about government intervention (except in my novels, of course) but this whole thing about forcing United States citizens to buy health insurance is about as insane an idea as . . . well, as aspartame, and that got shoved down our throats, too.

The main problem with our health care system is the insurance racket, and the government wants to reward them for stupidity with our money? Sheesh. Case in point:

I am taking care of my 96-year-old father, and he’s recently taken a turn for the worse. He was in the hospital for pneumonia and various tests for about a week. Got out about eight days ago. The doctor prescribed a breathing treatment, but when I went to pick up the drugs at the pharmacy that night, they weren’t ready. Somehow, the doctor had forgotten to send in the prescriptions. Several calls and one personal visit to the doctor’s office later, the prescriptions were called in, and that’s when the fun really started.

The insurance refused to pay for the breathing treatment, so the doctor changed to a different one — one, moreover that the insurance company said was covered. I went to pick up the prescription and again, it wasn’t ready. Turns out this particular drug needed a doctor’s authorization. Say, what? Isn’t a prescription an authorization? Apparently not. Apparently, the insurance company wanted the specific reason why the doctor had prescribed that particular treatment. So I started making calls again, to the doctor’s office, trying to get them to do the authorization; to the pharmacy, trying to get them to do their part. Finally, the authorization was sent. But . . .

The insurance company told the pharmacy to bill Medicare, that they don’t handle any aerosol treatments. Huh? So what was the whole thing about changing medications to one that the insurance company does cover? Anyway, Medicare agreed to pay for the drug but . . .

Yep, another but. As of this year, Medicare has a $148 dollar per year deductable, which means my father ended up paying the whole bill of $119.00 out of pocket. He pays a fortune in insurance, a fortune in co-pays though his insurance policy, and yet because the insurance company refused to honor the prescription, he ended up bearing the full cost. A refill, of course, will be only thirty dollars or so, but the problem is that this replacement drug needs to be taken four times a day, every six hours, instead of two like the originally prescribed drug. It will be hard getting my father to do the treatment even once, so we will have a year’s supply of the drug, which means that any refills will also be at full cost.

So, if he has to pay the entire cost of the drug out of his own pocket, why weren’t we told this upfront so we could have just gotten the original prescription and been done with it?

This sort of situation is becoming way too common. I have a friend who suffers from advanced rheumatoid arthritis. One particular very expensive injection is keeping the disease at bay, allowing her to continue living without too much debilitation, and yet her insurance company refuses to pay for the shots any longer. The drug company ended up finding a sponsor for her. So what’s the point of having insurance if you have to beg someone to pay for a drug you need to survive?

And this is the insurance hell that everyone is going to be forced to endure. Cripes. As if being sick isn’t bad enough.

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Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+

Tagged: breathing treatment, co-pays, insurance companies, insurance racket, medicare, prescriptions