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Yes, it's a yet another Fratching thread about health care, but in this case with a very personal focus...at least for me.
I grew up in Canada and have only been in the United States since early 2008. As such, I've spent the last four years adapting to the American health care system. When I first got here, I never knew anything about premiums, deductibles, co-pays and all that other wonderful stuff that goes along with having a health insurance plan (and please DON'T get me started on "pre-existing conditions". That's another rant for another thread).
In the past couple of years or so, I have had plenty of opportunity to learn firsthand how frustrating the system can be.
The way I see it if you have health insurance and the provider is supposed to cover something, it should be covered. Period. You shouldn't have to fight them tooth and nail to get the proper coverage or, in some cases, coverage at all.
This is where the personal part of the story comes in.
A few months ago, my wife went to the ER because she had a severe headache. A VERY severe headache. She doesn't get headaches like this often and given how much pain she was in, we were concerned it could possibly be more than just a migraine.
So the doctor examines her and says he thinks it's probably a migraine but he wants to have a CT scan done to be certain nothing else is wrong. This is a wise precaution as a severe headache can be a symptom of several potentially fatal conditions, including a stroke.
Fortunately, the scan showed nothing abnormal and my wife was given some pain meds and sent home and was feeling much better the next day.
The kicker came when we got a notice from our insurance provider stating they were refusing to pay for the CT scan as they felt it wasn't "medically necessary".
I have two problems with this:
1. Why does an insurance company and NOT a doctor suddenly get to decide what is "Medically necessary"?
2. Given my wife's symptoms, a CT scan was damned well "Medically necessary". I know this and I'm not even a doctor!
We are in the process of appealing this.
It gets better. My wife saw a neurologist a few weeks ago because she's been having intermittent pain in her back for months now. At first she thought it was a pinched nerve, but since the pain has continued and is very acute when it occurs, we began to suspect a spinal problem may be to blame (she's had back surgery once before).
The neurologist agreed with us and ordered an MRI on her to get to the bottom of things. An MRI is an expensive procedure.
Guess what happened next. Our wonderful insurance company denied the initial application for the MRI because (once again) they deemed it was not a "medically necessary" procedure.
Again I must ask: Why does an insurance company get to decide this?
And again: IT IS MEDICALLY NECESSARY. She's had back surgery before, she's having back pain again that is not going away with typical treatment methods so it's got to be more than a pinched nerve or sore muscle.
We are in the process of appealing this decision as well as she really needs the MRI and we feel (as stated above) it is very much necessary.
So I'm upset about this as is, but what really burns me is that my wife told me when I got my first health coverage in this country that "you WILL fight with your insurance company...a lot."
That's right, it wasn't an IF, but a WHEN. A guarantee. What if I was telling you about some electronics store and I said to you: "And by the way. The manager is a huge douchebag. He'll always try to screw you over. ALWAYS."
Would you shop there? HELL NO!
But with health insurance we don't get a choice, we can't just switch companies if the one we have isn't working out. Not to mention I know full well that ALL health insurance companies pull these kinds of shenanigans.
As someone who grew up in a country that had universal care, I never had to deal with this kind of bullshit. I went to the ER in Canada once in 2004 when I was uninsured. I was having chest pains. I got an EKG and an X-ray done (turned out to be a mild, non-cardiac issue). I would rate the care I got as good and the net cost to me for that visit was $0. I can only imagine how many thousands of dollars that would set me back had I been living here at the time.
Now I know that of course we Canadians pay higher taxes in exchange for Universal health care, but they aren't back breaking and they are, in my opinion, well worth it. I bet in a lot of cases, even IF Americans were paying slightly more in taxes for a single payer system, they would be paying LESS than they are now for their health insurance (have you seen how ungodly high the deductibles are getting??)
It's also worth repeating again that the United States spends MORE MONEY per capita for health care than any other country in the world, including all those nations that have Univeral care.
I simply can't believe that a single payer system would somehow be MORE costly and LESS effective than the broken system we have now. This is the argument some Republicans and "free market advocates" will make to argue against single payer.
Even IF single payer isn't the answer, the system we have now cannot be allowed to stand.
A fully privatized system is questionable enough. A profit driven privatized system that is out to screw consumers not only out of money but of VERY much needed medications and procedures is damned near appalling.
The American healthcare system needs to be fixed. Badly. The affordable care act (Obamacare) was a tiny step in the right direction but still did a poor job of addressing the problems that plague health care.
The sad thing is that I know full well there will be future fights with my insurance provider in the months ahead and I probably won't win them all. Who knows how much or how little my wife may have to suffer because some dickhead in a suit thinks that a procedure she obviously needs isn't "medically necessary"?
It's bullshit. A big stinking pile of bullshit.
And it needs to stop.
I grew up in Canada and have only been in the United States since early 2008. As such, I've spent the last four years adapting to the American health care system. When I first got here, I never knew anything about premiums, deductibles, co-pays and all that other wonderful stuff that goes along with having a health insurance plan (and please DON'T get me started on "pre-existing conditions". That's another rant for another thread).
In the past couple of years or so, I have had plenty of opportunity to learn firsthand how frustrating the system can be.
The way I see it if you have health insurance and the provider is supposed to cover something, it should be covered. Period. You shouldn't have to fight them tooth and nail to get the proper coverage or, in some cases, coverage at all.
This is where the personal part of the story comes in.
A few months ago, my wife went to the ER because she had a severe headache. A VERY severe headache. She doesn't get headaches like this often and given how much pain she was in, we were concerned it could possibly be more than just a migraine.
So the doctor examines her and says he thinks it's probably a migraine but he wants to have a CT scan done to be certain nothing else is wrong. This is a wise precaution as a severe headache can be a symptom of several potentially fatal conditions, including a stroke.
Fortunately, the scan showed nothing abnormal and my wife was given some pain meds and sent home and was feeling much better the next day.
The kicker came when we got a notice from our insurance provider stating they were refusing to pay for the CT scan as they felt it wasn't "medically necessary".
I have two problems with this:
1. Why does an insurance company and NOT a doctor suddenly get to decide what is "Medically necessary"?
2. Given my wife's symptoms, a CT scan was damned well "Medically necessary". I know this and I'm not even a doctor!
We are in the process of appealing this.
It gets better. My wife saw a neurologist a few weeks ago because she's been having intermittent pain in her back for months now. At first she thought it was a pinched nerve, but since the pain has continued and is very acute when it occurs, we began to suspect a spinal problem may be to blame (she's had back surgery once before).
The neurologist agreed with us and ordered an MRI on her to get to the bottom of things. An MRI is an expensive procedure.
Guess what happened next. Our wonderful insurance company denied the initial application for the MRI because (once again) they deemed it was not a "medically necessary" procedure.
Again I must ask: Why does an insurance company get to decide this?
And again: IT IS MEDICALLY NECESSARY. She's had back surgery before, she's having back pain again that is not going away with typical treatment methods so it's got to be more than a pinched nerve or sore muscle.
We are in the process of appealing this decision as well as she really needs the MRI and we feel (as stated above) it is very much necessary.
So I'm upset about this as is, but what really burns me is that my wife told me when I got my first health coverage in this country that "you WILL fight with your insurance company...a lot."
That's right, it wasn't an IF, but a WHEN. A guarantee. What if I was telling you about some electronics store and I said to you: "And by the way. The manager is a huge douchebag. He'll always try to screw you over. ALWAYS."
Would you shop there? HELL NO!
But with health insurance we don't get a choice, we can't just switch companies if the one we have isn't working out. Not to mention I know full well that ALL health insurance companies pull these kinds of shenanigans.
As someone who grew up in a country that had universal care, I never had to deal with this kind of bullshit. I went to the ER in Canada once in 2004 when I was uninsured. I was having chest pains. I got an EKG and an X-ray done (turned out to be a mild, non-cardiac issue). I would rate the care I got as good and the net cost to me for that visit was $0. I can only imagine how many thousands of dollars that would set me back had I been living here at the time.
Now I know that of course we Canadians pay higher taxes in exchange for Universal health care, but they aren't back breaking and they are, in my opinion, well worth it. I bet in a lot of cases, even IF Americans were paying slightly more in taxes for a single payer system, they would be paying LESS than they are now for their health insurance (have you seen how ungodly high the deductibles are getting??)
It's also worth repeating again that the United States spends MORE MONEY per capita for health care than any other country in the world, including all those nations that have Univeral care.
I simply can't believe that a single payer system would somehow be MORE costly and LESS effective than the broken system we have now. This is the argument some Republicans and "free market advocates" will make to argue against single payer.
Even IF single payer isn't the answer, the system we have now cannot be allowed to stand.
A fully privatized system is questionable enough. A profit driven privatized system that is out to screw consumers not only out of money but of VERY much needed medications and procedures is damned near appalling.
The American healthcare system needs to be fixed. Badly. The affordable care act (Obamacare) was a tiny step in the right direction but still did a poor job of addressing the problems that plague health care.
The sad thing is that I know full well there will be future fights with my insurance provider in the months ahead and I probably won't win them all. Who knows how much or how little my wife may have to suffer because some dickhead in a suit thinks that a procedure she obviously needs isn't "medically necessary"?
It's bullshit. A big stinking pile of bullshit.
And it needs to stop.
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