aphlamingphoenix , 5 months ago

Because insurance pays for a portion of your treatment, rarely 100% of it, and the moment you start racking up bigger bills, insurance starts looking for ways to not pay your claims. They’ll put a hold on payment until you call them and broker a deal or they go back and forth with your doctor demanding that you receive some treatment other than what that doctor recommends.

I have Crohn’s Disease, an autoimmune disorder that is often treated with immunosuppressants. First, they did not want to pay for my initial “loading dose” because it has to be done by infusion. That’s a ~$25,000 procedure (3-4 hours on an IV). I talked them into it by telling them that only the first dose would be by infusion and the rest by self injection.

But when my company decided to pay for a less expensive insurance plan that started at the beginning of the year, they suddenly didn’t want to pay for the injections either. Now I owe 30% of the cost of my injections. That’s almost $4,000 a dose that I take every 8 weeks, about $25,000/year.

So now I use a coupon program through a separate company, and they bill the remainder of the balance to the company who produces the medicine who give me a $21,000 annual credit toward paying the remainder. So now to get my medicine I must coordinate between my doctor, a specialty pharmacy, my insurance provider, a company that runs the coupon program, and the company that produces the medicine… Just to get a syringe delivered to me on a schedule. And the credit probably won’t last until the end of the year; I’ll probably end up shelling out a few thousand for my meds around Christmas time this year.

If any of the complicated web of companies that collectively get me these meds doesn’t have everything lined up in their system, I don’t get my meds. My last dose was almost three weeks late to me because of all the calling around I had to do. Because we don’t have a central health care authority, that means each company maintains their own system of record. Each phone call involves working through a phone tree to get to a human agent, working through the same set of identity verification steps with them, explaining the situation over again to a different person every time…

It’s a real pain in the ass, and they do it on purpose to get you to give up. Having insurance doesn’t mean your health care is paid for, and you pay a premium (hundreds of dollars) on every paycheck to keep the insurance that still doesn’t pay for your medical costs. Having health insurance does not mean you don’t still pay through the teeth for your health care. Having health insurance does not mean that health care is accessible to you. Having insurance that makes health care accessible today does not mean they won’t change the rules behind your back, and that you will still have access to health care tomorrow.