An unnecessary death

ICanDoThis

A few weeks ago, I posted about having a dear friend, who had moved out of town being diagnosed with DCIS just as I was finishing up my treatment.

Within days of her mastectomy, she got an emergency phone call from her family - Her sister, who had no health insurance, and who was trying to ignore the lump she had found in her breast, was in the hospital with Stage IV mets, and could she be there?

Well, no, she couldn't drive 6 hrs a few days after a mastectomy, so she was very grateful when her sister recovered enough from the coma from the pneumonia from the lung mets, and the liver mets, so she was able to spend some time with her before her 50-year-old sister died, leaving 3 20-24 year old children.

I AM SO ANGRY!

What kind of a country do we live in, that this is acceptable?

mke

One where health policy is determined by insurance companies.

anneshirley

First, sorry about your pain and your friend's loss.  You ask what kind of country do we live in, and is this acceptable? 

It's not acceptable to me although, now on Medicare, I have excellent care, but so many don't--about 50,000,000 at the moment.  But it apparently is acceptable to the rest of the country since we're in the midst of a national election, where the so-called liberal nominee refused to stand up for mandated health care, yet gained the nomination over the candidate who supported universal health care. And this supposedly on the caring side of the house.

On the other side we have a candidate who wants to give a tax credit so people can buy their own health care, a $5,000 credit.  First, you would have had to pay $5,000 in taxes to use the credit, which is not the case for a large number of our citizens.  John McCain is covered under a government plan, as I am, so perhaps he doesn't know that $5,000 will hardly cover a family of four purchasing health care.  In 2001 I was paying $1,000 a month for my husband and me.  For sure it would be closer to $2,000 a month now, or $24,000 a year. i wonder how he stumbled on that number? And for sure he stumbled.

It's an absolute disgrace and I join you in your anger. 

LuAnnH

we have a girl on the mets board who just went through this horror!  She had no health ins and the onc she was working with would treat her only if she could get the chemos paid for by the mfg.  That worked for awhile and then the onc said there was no more to be done and sent her to hospice.  Once we found out what was happening we helped trying to find people to help her with no insurance.  In the meantime medicaid got approved (her family made a little too much before to be approved for this).  Anyway, she is currently in tx again and improving but if left alone she would be close to death right now.

iodine

Another example of insurance mess I discovered today: my ps no longer does ins. cases, so no more recons.  He was one of the last in Nashville, a fair size city, to stop taking ins.  I was given the name of ONE ps there, who is of course kinda new, who DOES take ins. 

I am unsure if Vanderbilt plastics refuse ins also.  Ain't that a kick in the head!  The ins. co's are running more and more docs away from patient care.  My pcp's office, with like 13 docs, accepts no new Medicare patients.  Fortunately, I just got it and have been followed there for  6 years, so I get to stay.  (yipppeeee, I now save $2,200 a month in  private ins premiums)

LuAnnH

Is that legal?  We are entitled to have our recon done from cancer!  Not sure what exactly the laws state but I bet those male doctors would get bent out of shape if pharmacy quit accepting there rx's for viagra!

NancyD

LuAnn, the insurance companies only have to cover recon to the extent of the policy coverage for any other surgery. And ps's don't have to take insurance...that's their option. Many don't bother since it's not usually covered by insurance at all. It's a cash business.

If I can find an in-network ps that does the kind of recon I want, I will still have to pay 20%, as that is what my policy covers for all surgery.

When you have out-of-network coverage in your plan, you can pay the dr up front and get reimbursed to the extent of the policy (usually 50%). Many women go to the best ps they can afford under their insurance, but many more choose to bite the bullet and find the best, cost be damned, even if they are out-of-network.

So the law that says insurance companies have to cover recon is only as good as the policy that covers you and the doctors in that network.

wishiwere

Isn't that the truth?  ALL of it!

B/c of the insurance problems we have going on, we've been checking into individual policies in case it dosen't get taken care of before the 62 days is up.  It's somewhere between 900-1000/month and that's about 600 more than we paid with the group with dh's work. To top it off, either policy pays up to $2500/yr script max (for all drugs), I hope per person, and not per policy!  Then the one pays 100% up to $100 max per script, the other 50% up to a max $100 per script!

Since Arimidex is nearly $400 at the local pharmacies (i have no idea at the mail in types), that means, we'll have to shuck out the other $300 a month or $3600 a year for that ONE med, not to mention the others.  I've been just ill trying to decide....higher monthly, and higher % coverage, or lower monthly and lower %coverage.  IT's just nutty!

And tell me why it's cheaper for us to get 2 individual policy as oppposed to a 2-person policy?  Makes absolutely NO sense to me what-so-ever!  I hate insurance, but it's a necessary evil for sure!   And I hate more, that I CAN afford it, while dd and many of her friends are without, and older people who need care and can't afford it, b/c they aren't retirement age yet at 60!  Geepers!