I don’t think I will ever understand health insurance companies. Some of the decisions they make and things that they do and do not cover just amaze me.
This came to mind recently when I heard about a friend of mine that has a new health scare. My friend is in health care and has been for a few decades so she has an understanding of what needs to be done. She needs a certain test. Her doctors know she needs this test, however the insurance company says she can’t have test “B” until she has test “A.” The doctor feels she doesn’t need test “A” but that’s the only way insurance will pay for test “B.” So while she goes through with test “A” (which her doctor feels she doesn’t need), we waste valuable time, and MONEY, on a test she doesn’t need. All so she can get the test she does need days or weeks later.
This reminded me of the time I was in rehab after my stroke which was now nine years ago.
I was at Southeast Rehab at Charlton Memorial Hospital in Fall River. I was transferred there from St. Luke’s on a Wednesday afternoon but I never arrived until almost 3 p.m. so no work really got done that day. The next day, Thursday, I met the doctors and the therapists and we set the schedule and did a little bit of rehab. Friday was a full day but then came the weekend when there was a smaller staff and we didn’t do as much work.
Monday came and I had “technically” been there five days so everyone involved in my case had a meeting and the team, working within the insurance company’s guidelines, decided it was time for me to go home the next day.
That’s when my wife stepped in.
At the time, she had a wonderful management team at her company and the vice president had told her that if we needed anything, just call. So Priscilla called. She explained everything that was going on and he said, “Let me make some calls.”
The next day my wife came for a visit and was greeted by one of the people on my “team” who said, “I don’t know who you know but Pete has been approved to stay as long as he needs.” My “team” agreed that I needed more rehab but their hands were tied with the insurance company, until this VP stepped up. I would have never had the success that I did if I didn’t have someone to fight for me.
Which makes me wonder: How many people never get the services they need because they don’t have someone to fight for them?
I’ve written before that I don’t understand how some “bean counter” who has never met me can determine what it is that I need. I know, it’s probably some “formula” they use but every situation is different.
It’s crazy! And it’s not right!
I’ve heard from a number of doctors how they are frustrated with what the insurance companies demand. When they first decided to go into medicine this wasn’t something they signed on for. They want to treat patients and order the tests or the medications they need. I can’t tell you the number of times our family doctor has prescribed one medicine only to have the pharmacist call and tell us the insurance company won’t cover it.
And don’t get me started about how these companies are all different. My wife’s employer seems to change insurance companies every year. You can’t really blame them as I’m sure they are just looking for the best deal. It’s just so much fun to change insurance companies every year and have to hand your doctor a new card and get used to the co-pays and the deductibles.
No, it’s not right.
So what’s the answer? Honestly I don’t know. However, I can’t believe that SOMEONE doesn’t know. There are plenty of people way smarter than me that should be able to tackle this.
I’ve heard good things about Universal Health Care but I’ve also heard some bad things. Is that the answer? Depends on who you ask.
I wonder if this will ever be addressed. If you ask me, one of the biggest problems in this country is greed and I don’t see that ending anytime soon.
Do we have anyone brave enough to stand up to the health insurance companies?
Maybe someday.
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