Jul 182013

I have been getting very frustrated lately with the insurance company denying 90% of what my doc orders for me. The bastards make me jump through all these rings of fire (tests), submit this form/that document, jump through a few more rings… and DENIED! Oh but wait! You can appeal the decision… more rings of fire, more forms, more documents… interviews… long phone calls… DENIED again!

Bastards. They are using up all my flippin spoons!

The one new (to me) medication they approved, Requip, didn’t do any good for me. It kept me awake… so that was a bust. Tecfidera and Ampyra have both been denied. Twice.

And the icing on the cake?

I was listening to Obama’s speech today… color me dumb… he was talking all about affordable health care and how wonderful it is. He was appalled there are politicians in Washington who are still beating that old dog (or something to that effect). He couldn’t believe they won’t let it go and worry about more pressing matters.

Obama went on to talk about how much money it’s saving the middle class.

I’m middle class.

He talked about the billions of dollars in rebates sent to folks last year because their insurance company didn’t follow the 80% rule… basically, 80% of the money from premiums is supposed to cover medical care. Only 20% is supposed to be used for adminstrative expenses by the insurance companies. So if the insurance company spends more than 20%, which encroaches on teh 80% to be used for the insured’s medical care… well then the insurance company is supposed to send a refund check for the difference to the insured. For example, if an insurance company makes a faux pas and spends 40% on administrative leaving only 60% of the premium for medical care, then a check for 20% of the premium paid is supposed to be sent as reimbursement to the insured.  He also talked about how premiums are lower than they’ve been in years, co-pays are lower than they’ve been in years….

I don’t know about anyone else but I have not seen any of this.

I have not received an refund check. Ever.

My premiums have gone up… and they go up more each year.

My co-pays have more than doubled.

And my coverage sucks… well, the medication part sucks. The treatment part is great because I work for a hospital system.

Have any of you received a check from your insurance company? Has anyone’s premium gone down? What about the co-pay?

I have this great fear that in the next 5 years I won’t be able to afford premiums, co-pays, or medications. In fact, I’m afraid more things ordered by my doctor will be denied. I am afraid this chronic progressive shitty disease will render me invaluable to the American government and therefore, a waste of their time & money.

That’s my fear.

Being an adult is like looking both ways before you cross the street and then getting hit by an airplane.

  9 Responses to “Healthcare Woes”

  1. I know little about the politics etc in USA but so want Obama to do the right thing/be allowed to do the right thing. I believe he really cares and wants to change things and I don’t think I can bear to be wrong. I also don’t think I can bear to see our NHS be destroyed here in the UK. I believe that all human beings should have a NHS. Sorry your % confuse me but I want us all to be ok. Maybe I’m a dreamer……

    • I wish everyone could be ok as well. I just don’t know what the answer is. What’s happening right now isn’t ok… Change, any change, is difficult. The transition period to something new is always hard and there are people who suffer through that transition. My biggest problem though is that I work very hard for what I have… which isn’t much anymore with all the taxes and such… and I barely make enough to meet my basic needs. This is going to sound horrible and I don’t mean it in a horrible way… There are a good number of people who don’t help themselves. They don’t attempt to earn any money because it’s being mailed to them once a month without having to do anything. That’s my money. And it makes me mad. Now, there are also people out there who are not capable of helping themselves whether it be from physical or mental challenges…it doesn’t matter. This group of people I don’t mind paying for. Not in the least.

      The really sad thing here is that I have always donated to charities; I have always given away food and money to those who need it; I have volunteered my time and services more times than I can remember to help people out who can’t do for themselves…. and now there’s nothing left in my bank to do any of that. Instead it goes to the government who puts it in whatever fund they think is most worthy and the people who really need it… the ones who can’t care for themselves… they don’t get it.

      I have been working since I was 15 years old… minus 1 year and 9 months over that time period. I have paid all my taxes, medicare, social security, and etc. When I was ready to file for my disability and get the money back that I have paid in for my own care should I need it… I can’t get it! The money isn’t there anymore. The government is broke. So they are denying claim after claim after claim. That was my money. And I know at least some of that money bought some cool ass rims for some car, it’s bought umpteen cases of beer; it’s been used for vacations and what not. I see it happening all around me every day. I stand in line at the grocery store and watch people with food cards trade for cash. I’ve seen people selling their benefits for cash.

      Those are the people who piss me off. Those are the people who have caused the system to fail. And those are the people who won’t go out and work. Why should they? All they have to do is walk to the end of the yard and open the mailbox.

      Ok, I’m off my soapbox now 🙂

      And I too want everyone to be alright. I really do. But I want to be alright as well.

  2. HA! A refund check…that’s funny!
    Although at the moment I can not complain NEARLY as much as in the past. When I was covered by my EXs company, I can NOT even begin to explain to you how little they covered and how many hours I wasted arguing over stupid, insane shit. FOR INSTANCE….when my first child was born, I received notification that a LARGE portion of the bills that were submitted to them because of said birth, had been denied. THE REASON….patient was not covered at the time of the procedure. OK so if said patient was ME, then perhaps a moment to panic, had EX paid the bills? BUT the patient they were referring to was….my son…that one that was coming out of my vagina at the time! And so any and all bills pertaining to patients SMS (sons initials) were deinied. Not once, or twice,…it took me 11 months to get this resolved. (I would like to point out that in the state that we live in, one has 30 days after the birth to notify the insurance company of the “NEW INSURED” ie THE BABY that you were giving birth too! 30 days seemed reasonable. EVEN if you had gone through a tramatic birth with complications, I would feel confident to say that within 30 days SOMEONE in your life would have it together enough to contact the insurance company. For me….I notified them the DAY AFTER I gave birth….ONE day! So it is not as if I was in any danger of NOT notifying them in time. They just kept denying and denying and denying. UNTIL one day, I got on the phone with about the 10th supervisor and he took one look and said and I quote “well this is stupid, you were giving birth to him of course these expenses would be covered.” DONE! BUT had I not hounded them for almost 10 months, we would have been on the hook for almost $3400 and I can’t help but wonder how many people just don’t have the TIME, the PATIENCE and the TENACITY to get to that FINAL call when they DO pay up!
    Sorry to hear that you are going through this stuff:(

    • Oh my word!! I think the folks they hire to work at those insurance companies are a big batch of boobs. I mean really… did they really expect you would be on the phone as you are shooting a kid of the nether regions to report an addition to your policy??? Holy shit!

      I’m glad you were persistent. And I’m really glad you finally got to talk to someone with some sense!

  3. I thought when this all started, and still think now, that Obama and his minions are lying asswipe pieces of shit, and that we didn’t need the goddamn government involved in healthcare. They fuck up everything they touch, they’ve exempted themselves from this ‘great’ system, and I seriously hate them all. Feel free to delete this comment, I know it’s full of profanity, which isn’t everyone’s thing… there aren’t enough dirty words in the language to heap on the shitheads who brought obamacare to the world.

    • I WILL NOT delete your comment 🙂

      I love it! I love that people can freely express themselves and if that involves cursing a bit here and there, so be it… I have a very hard time with our current administration as well. I feel as though I’ve worked hard and done the right thing (for the most part) and now I’m paying the penalties. I’m suffering so others won’t have to. I thought the whole stupid idea was that NO ONE suffers… pft. That’s an impossible dream.

  4. Hiss and spit. Your medical system scares me. Our medicare is by no means perfect, but it is accessible and low income earners, or middle income earners don’t miss out.

  5. You are definitely not a burden for me…Or a waste of time and effort…….

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