3 things that piss me off about health insurance companies

3 things that piss me off about health insurance companies

I will be honest, I am nervous to write anything about health care.  I do not fully comprehend everything happening and do not always have faith in the sources I read, for I fear they are motivated by an underlying political agenda.  So I seek out sources that seem to represent the middle position and just list facts. But there are three things that have really pissed me off!  In general, I rarely get pissed off, but if you allow me – these are 3 things that are f—ked up!

1.            From what I understand, all women will be able to receive FDA- approved methods of birth control under the new Affordable Care Act.  But the fact that there are 100 lawsuits clouting our judicial system because some companies are rejecting the birth control coverage due to their religious reasons is f—ked up!  Someone explain to me how this benefit can be taken away from women if it is part of the Affordable Care Act? Click here to read more on this topic.
2.            Can you believe that some states like Tennessee that have switched various guidelines for care are no longer covering limb-saving treatments.  Seriously?  Limb saving is being demoted as a necessity?  How can this be? Apparently, Milliman Care Guidelines ( MCG) believe saving a person’s limb with preventative treatment is too costly (treatment that was once covered/approved).  So the unfortunate people of Tennessee that face potential limb loss that are covered by BCBS, are now condemned to have MCG - based system of coverage to pay for their post-amputation therapy and care.  
I realize everything comes down to money. But how can insurance companies deny someone the medical care needed to save a foot or hand for that matter.  I guess the cost of their occupational therapy for years, nerve damage, blood clots, physiological treatment for coping with the trauma, blood flow problems ….  do I need to list more is cheaper than simply saving a limb?
3.           Let me end my rant with my own personal story.  So I have a neck injury.  No need for details.  It was doctor recommended that I do block injections, steroids and an epidural.  I thought, no problem.  This sounds great!  No surgery, sign me up (I ‘ve had many surgeries in my career- avoid at all costs).  Of course, I have to do physical therapy as well.  Had the injections twice.  It went well.  So my physical therapist, who is also trained/certified to perform dry needling (which now has a code for insurance companies) is utilizing this extra treatment in my care.  It is working wonderfully.  So my physical therapist calls the new third party insurance company to discuss her payment (because she has not been paid after 7 weeks).  She wants to  update them on my status (as is required) and let them know  that the dry needling is working most successfully.  She suggests that I an NOT discharged yet.   The goal of my PT is to just  get additional dry needling sessions, which is actually cheaper than the full PT session.  My new orth-care insurance company told my PT that they could not give me more sessions because, “ you only need to get her [meaning me] back  doing activities like house work, ya know like dishes, laundry and things like that.”  Can you believe it?  My PT of course responds in saying, “if I discharge her now, she will just get re-injured and end up needing to start all over again.”  My new orth-provider responded by saying, “ Then I guess you’ll get her back as a full patient again.”  That is s pretty f--ked up comment!

 

I hope it was not too painful to read through my rant.  I realize there may be more to the story, like MONEY.  But these stories undermine the concept of having faith (general faith ) in others.  The ‘others’ are those in positions to make decisions to do the right thing for humanity.  Religion should never be involved in implementing any type of policy, government based or otherwise.  When religion is used as a form of reason, we are simply not being truthful or objective.  I am not going to quote the constitution, because it was not the government that interceded on this birth control-bullshit; and honestly I respect faith based belief systems. 

As for BCBS of Tennessee changing the guidelines they follow, they should be ashamed.  This is one of the most inhumane things I have heard of.   BCBS should create an amendment to their new, more cost effective policies that says, ‘All procedures that can prevent unnecessary amputation that were once approved will be covered.’  As for my personal experience, I have decided to quit my job, and I am now focused on getting my housework done.

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