Wednesday, October 3, 2012

President Obama, Mr Romney, You Might Want to Read This

My thoughts on the debate:

It’s 10:24, Jim Lahrer just admonished both candidates by reminding them that they each have only three minutes to answer and they better behave and listen to him for once or else!

Yes, of course I watched the debate.  Now my head is spinning and aching.  I can’t wait to flip through the various network channels now so that the talking heads can tell me what Mitt Romney and Barack Obama really said.  Oh yeah and they will also let me know who won.

Talking heads on the Body Language of the candidates:

Romney looked a little over aggressive.
Obama looked a little peeved and stiff.
Romney didn’t know when to take the foot off the pedal.
Romney looked a little more comfortable.
Obama didn’t look like he wanted to be there.

Well, that certainly clears it up for me.

A lot of time was spent on the "health (really?)care" issue.  Mind blowing, unfathomable numbers of trillions and billions of dollars were tossed back and forth between the candidates.

Mr. Obama, Mr Romney, as you read my blog today, please take notes for future consideration.
I am a living, breathing, individual person.  While there are rare occasional times when I think of money in thousand dollar increments, generally my bookkeeping spreadsheet contains 3 figure numbers, with the first number usually being a one.

I recently experienced an incident which may shed some light on what real people deal with on a daily basis as they try to navigate the choppy waters of the "health (really?) care" system.

My personal story goes something like this.

About three years ago, I was diagnosed with a non-life threatening but bothersome condition.  My doctor prescribed various types of medications for me to try until I finally found the one that worked.
I take this drug on a daily basis and it has helped me tremendously. According to my doctor, the drug is safe to take long term, but I also cannot stop taking this medication cold turkey.

I turned 65 in July.  My insurance company immediately stopped coverage and I was automatically enrolled in Medicare.  At the same time we discovered that it was more economically beneficial for us to switch over from my former insurance company's supplemental coverage to the family plan that was offered by the insurance company that Ross is covered under.

We are covered for prescription drugs under our supplemental insurer.   They use a different pharmacy than the one I was formerly using.

Last Friday I mailed my prescription to the new pharmacy.  I received an email on Monday from the pharmacy informing me that payment for my medication was denied by my insurance company because it is not on their list of what they consider acceptable drugs.  Actually, I'm pretty sure that "acceptable drugs" are determined by cost, not by quality or efficacy.

Ross and I spent an entire afternoon on the phone with each of the players.  The first call was to the pharmacy to find out specifically why they were refusing to fill the prescription.
The second call was to the insurance company.  Of course Ross was sent from one customer service representative to another before he finally talked to the "Right" person.
The "Right" person directed Ross to the area on their web site which contains a list of drugs that they, the insurance company, has deemed acceptable.
The drug I take is on what they call the "exclusion" list.
It does not come in a generic form, which is why, I assume, it is on the excluded list.  It is also very expensive costing $10.00 a pill.
On the exclusion list, next to the name of the drug I take, are two alternative medication which, although are not chemically exactly the same as the drug I take, they are also commonly prescribed for my condition.
Both of these drugs are drugs which I had initially tried before I found "my" drug, the one that worked for me.
Ross explained this to the "Right" one.  She told us that there was really nothing she could do. She suggested we contact my physician to inform her that she would have to write a new prescription for one of the drugs that is on the acceptable list.  She also told us that we could write a letter of appeal to the insurance company and that we could contact the pharmaceutical company that manufactures the drug because they may be able to help defray the cost of the drug.

I then made a phone call to the pharmaceutical company that manufactures my drug.
That customer service rep had two suggestions for me.  She gave me the phone number of the department that would review my case and if approved, might be able to help defray the cost.
Her second suggestion was to switch insurance companies.

Since I did not want to be without any medication I felt that I had no other choice.  I made the phone call to my physician and requested a new prescription for the drug that the insurance company will pay for.

I am concerned and quite stressed out because I am afraid this new drug will not be as effective in treating my condition.

I wonder why we just don't go to the insurance companies for our physicals.  They seem to have taken over the role of diagnosis and treatment.


While I am sure my story is not unusual and in fact probably quite typical,  I know that many, many other individuals are dealing with this sort of nonsense. These are individuals who are suffering from life threatening illnesses. These are people who are fighting to stay alive for one more day, one more month. These are patients who come home after going through hours of painful, uncomfortable, stressful procedures and treatments, to find mail from their insurance companies denying payments.

How many hours and hours have you, Mr. Romney and Mr. Obama, spent on the phone dealing with insurance companies, appealing denial of payments?



I have created a page for Anna's Diary.  It can be found under the Tab titled Anna's Diary.
I have posted all of the entries to date there, starting with January 1, 1929.

Here are yesterday and today's entries from Anna's Diary:
Thurs. October3, 1929
Home all morning. Brought Junior to 360.  Went to see Nick Lucos at Proctol's.  Met Elizabeth M. at 2:30 and went together.  Had supper at 360.
Friday October 4, 1929
Home all day.  Violet and Harriet came over to play with Junior after school.  Sally came over to see Ted after supper.  I went to bed early.

11 comments:

  1. I don't know that I'd want to be spending my 20th anniversary debating someone. Just sayin'.

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    1. I have a feeling that Mr. Obama didn't want to be spending his 20th with millions of people either.

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  2. "I wonder why we just don't go to the insurance companies for our physicals. They seem to have taken over the role of diagnosis and treatment."

    So true. Why are there so many hoops to jump through?

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    1. Hoops indeed! That's just the way it feels!

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  3. Soooo true. Dealt with the insurance companies when my hubby was dying. It was a horror show. I recall crying hysterically because i couldn't get an "ok" for a pain killer for a long holiday weekend. HOURS on the phones, finally broke down in the drug store, had a kind man literally help me stand, and took me out of the store and told me to go next door and ask for a pharmacist he knew, and after I had nothing left to loose, did and the pharmacist made calls and got the medicine. HOURS it took and from then on, he made sure I had a supply. I watched the debates and afterward told my husband about all the horrible experiences I had. I told him I am AFRAID of the state of the coverage. I want to make changes in my life, but can't risk losing the insurance so I stay the course, and it is sad. My mom had to go to PA to get coverage for an allergist (she lives upstate NY) as 3 doctors weren't taking any more of "her" kind (read 72 and Medicare). Sad, as her throat kept closing up and to send her out of state to find out why she couldn't breathe is unbelievable to me. I think patients and patients families need to be involved in the "fix" of this. Not just doctors.

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    1. I understand how difficult that must have been for you and your husband. I am sorry that you had to go through that. I feel that instead of fighting over who pays for what, the health care system needs an entire overhaul. And I agree patients and their families should be involved.

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  4. When it comes to healthcare, The USA may as well be a third world country. It's sad when other countries take better care of their own than we do. Not to mention the ugliness that has come out of the healthcare debacle.

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    1. I totally agree! And you are right it is a debacle!

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  5. While reading your post, I kept going back to the images I have of Joe (and me) on the phone with the insurance company (and care providers) during his illness. In fact, we were never able to get them to pay completely for his EMERGENCY surgery that led to his diagnosis. Dealing with the insurance company over that surgery was one of the very few times I ever recall seeing Joe angry. No patient or family member should have to go through that while trying to get better (or even after they are better for that matter!) Thanks for sharing your experience. Unfortunately, I'm sure most people have similar stories to varying degrees. When care is about profit, it is the holistic care of the person that suffers.

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  6. Very sorry to hear of the fiasco that you had to go through. I have been fighting my 3rd cancer with Radiation and Chemo. So far no problems with the meds but the company we have had for about 4 years keep dropping certain meds. I had Adrenal cancer in 2000-2001 and my first session of Chemo arrived at my store and i was told that I had a co-pay of over $3,000.00 in order to get the package. The next co-pay 3 weeks later was about $750.00. i had never heard of such a thing and at that time my husband had good insurance but there was no fighting this. At least now I am geting the medicines that I need and they come from the Pharmacy in the Praxair Cancer in Danbury. No matter whar your politics are or who you intend to vote for something has to be done. If this time was the same as last time, I would probably be dying now. Just came home 1 hour ago from Radiation and Chemo and have more scheduled. What if I still had the other Insurance Co?

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  7. I think if politicians in general, and these two in particular, had more experiences like the one you relate here, things would change and quick. Part of the problem is that most of the people making the biggest decisions are in a whole other world than the rest of us--and the corporations (in this case pharmaceutical and insurance companies) have FAR too much influence while the "little people" have almost none, but still live with the consequences of the decisions. There needs to be a serious shift in the balance of power...which will likely never happen because the "people" who can put their money where their mouths are are quite satisfied with the status quo.

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