Health insurance companies dictate our health care in America. I’m not sure how many of you pay monthly for health insurance and then turn around and you can’t get a medication or a procedure you may need. Why? Why do we have to get approvals from people working behind a phone hundreds of miles from us? Another question is why do we continue to pay high rates and get little in return. There are so many insurance companies out there, but it seems like no matter which one you get you will somehow be cheated. Despite having the most expensive health care system in the world, the US ranks last overall compared to Canada, Australia, Germany, the Netherlands, New Zealand and the United Kingdom on measures such as quality, access to care, equity, efficiency, and the ability to lead long, healthy and productive lives.

               Did you know that America is the only wealthy, industrialized nation that does not have a universal health care system? Paying for health care is the number 1 cause of bankruptcy filing every year in the U.S. Almost 2 million people need to file bankruptcy because they cannot pay their medical bills each year, and outside of bankruptcy, over 20% of the population (about 56 million adults) between the ages of 19-64 struggle with health care related bills each year. This has to stop! I feel so helpless and I don’t even know where to begin to help change this. I worked in a doctor’s office for almost 8 years as a nurse. Part of my job was to call insurance companies and obtain approval for patients to have surgery. This was the biggest pain about the job. There are currently twelve health insurance companies in Pennsylvania. There are also different plans that a member can choose when selecting an insurance company. Some insurance companies didn’t require a patient to have authorization prior to surgery, others only required it if the patient was going to be admitted after surgery. On top of it being a hassle, it would also get very confusing. The frustrating part was when a surgery would get denied due to it not being “medically necessary.” Now remember, the surgeon has reviewed the patients testing and discussed the patient’s symptoms and treatments thus far. When the doctor schedules a patient for surgery, that is him saying that it is medically necessary for the patient to have surgery to improve quality of life.

               I’m not sure who is making the decision on the insurance companies end. Some of the doctors that work with the insurance are retired family physicians. I’m not saying that family physicians lack education, but I am saying that I would prefer a decision on a spine surgery come from a spine specialist. The insurance companies do not have the patient’s images in front of them to view, they just have the office notes and reports to read. Sometimes even the radiologist wouldn’t grade the level of stenosis on a patient right. This is such a petty game. The insurance company wants to deny the surgery because the patient has moderate symptoms and not severe, or the patient only did 8 weeks of physical therapy and not 12. This happens all the time, I just wanted to use the spine for example because that is how I experienced dealing with insurance companies.

It feels like your health is up to the insurance company. I have had plenty of times where I have been on a medication for years, and then all of a sudden, the insurance company wants to deny it. Just today for example I went to the cardiologist and the doctor wanted me to wear a monitor for 7 days to record my heart. I have Aetna Better Health for insurance and they will not cover that specific monitor the doctor wanted. Now I have to wait for a different company to mail me a monitor to wear for 7 days. This whole mess because of an insurance company! This is ridiculous. I have tried multiple times now to get an appointment with a therapist, however because I have medical assistance, I am grouped into this “group” of “low lives” and nobody will accept me as a new patient. The reimbursement rate for medical assistance is lower than other companies, and for that reason a lot of doctors do not want to see patients with this insurance. Think about that a little bit more. Yes, a doctor can simply decide they do not want to see you because your insurance is Medicaid, which is a public assistance program based largely on financial need; it’s paid for with public funds collected through taxes.

Medical assistance, or Medicaid, is there to help people out with medical bills and such. I’m sure there are there people who are not that ill and try to work the system to get free healthcare. Just between January and March 31, 2019 there were 178 Pennsylvania residents charged with welfare fraud. This makes everyone who has welfare look like, for lack of a better word, a piece of shit. Unfortunately, it becomes very easy for physicians and businesses to look down on patients who have this insurance. I have been in that position before. It makes you feel like a scumbag. I have always shown up to my doctor’s appointments on time and have been compliant. However, thinking back to when I worked at the doctor’s office and we had no shows I would say 90% of them did have medical assistance. Do some people try to beat the system? Yes. Do some people work their butts off and try to do the right thing in life? Yep! It becomes frustrating to a certain extent in life. I was on a program called MAWD, which stands for Medical Assistance for Workers with Disabilities. I had to pay for this each month, and the monthly payment was based off of my income. The highest I ever had to pay for my mawd insurance was $98. I never had to pay a co-pay, and almost all of my medications were covered. When I was working, I had to also take the insurance my employer offered. I was covered under Highmark at one point, but switched to Geisinger due to changing jobs. I had been going to a doctor at the Cleveland clinic for 4 years, however they did not accept Geisinger insurance so I ended up having to find a new doctor.

Dealing with health insurance is a constant struggle. You finally find a good treating physician and then you end up losing them because of your health insurance. This is not how it should be. We shouldn’t be dictated by our insurance companies on who we are able to see. Sadly, in America that is the way it is. I don’t know how to change it. I hope in the future this problem changes. Roughly 26 million American’s have no health care, which makes their access to care limited. Can America change? Does anybody else have a ridiculous insurance story? Thank you for taking time to read my rant. I am on prednisone right now, so I have plenty of rage in me 🙂

References:

 The Commonwealth Fund; U.S. Ranks Last Among Seven Countries on Health System Performance Measures. https://www.commonwealthfund.org/publications/newsletter-article/us-ranks-last-among-seven-countries-health-system-performance

Meritage Medical Network; 12 Surprising Facts about United States Health Care https://meritagemed.com/surprising-facts-united-states-health-care/#:~:text=The%20total%20amount%20of%20money,spending%20each%20year%20is%20wasted.

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