Living with MCL

Well at least how we pay for it is certainly in question.

Here’s another in the continuing saga of health care woes another person (from one of the many health related message boards I belong to) just encountered in dealing with his health insurance company.

After receiving IVIG monthly for 1 1/2 years and no problems with insurance paying, had 1st treatment this month and denied. No change with insurance company or employer. Called insurance and they stated the drug is one of 6 that my company has chosen to bill under seperate drug benefit and not medical.  Called pharmacy plan and their notes on the drug state to call my company HR department as the drug is not covered.

Great news to find out friday after everyone is gone for the weekend…  This is the first battle that I have come upon since diagnosis and preparing myself to justify this treatment after I speak with the HR department and then whomever heads the committee that might have decided to not cover the drug. Any advise from others who might have run across similar denials.  Any organizations that people have found helpful to help fight such a thing?  Trying to stay optimistic that this will be resolved as I can’t find $6000.00 per month to pay for this as most will understand.

That certainly isn’t great news, and I sure hope he gets it resolved, but as health care costs and insurance premiums continue to rise, expect this to become common place as patients are expected to bare more of the burden of paying for their own health care.

This is just a perfect example of how little people understand their insurance policies. Most people don’t know how under insured they are until they get sick, and need to use it. Then it’s too late.

If we don’t change the way we pay for and deliver health care in this country soon, only the richest among us will be able to afford health care.

It’s raining outside, and as you might expect, I am bored [big time].

So I thought I would give you a little taste of some of the discussions I’ve come across on the various list serves I belong to in relation to my MCL, which I made particular note of, concerning medical care and what ever.

In this first post, a woman is complaining about the poor care she is receiving from her primary care physician (PCP).

I left my PCP’s office in tears today. I’ll give you a little background, when I do go I usually have to wait 1 to 1/2 hr to even see him, then, he’s with me for about 2 minutes. <snip>

Anyway, I’m in constant pain, I mean constant, with the RA, the joint pain from the chemo, the bursitis and degeneration in my hip, the carpal tunnel in both hands, all of which happened after chemo. The Doctor came in and said “what’s going on today” I said “I’m in pain” his reply “again?”. He says “I’ll send someone in with your prescriptions” and started leaving the room, I said “wait” and he replied with “I’ll be right back”. When he came back I asked if he has even read my chart concerning all the pain I’m in, he said yeah but he was more concerned with the “cancer”. He proceeded to leave the room again and I said I wanted to talk to him about some things, again, he said he’d be back. When he finally came back I asked him about a pain management program because I want to work, which is getting harder every day. He said “let’s wait until after your pet scan and we’ll worry about it then” I just felt like he was saying let’s wait to see if worth the trouble or not or let’s see if you’re going to live first, then he left the room, all this happened in about a 2-3 minute span.

<snip>

I have to go to Doctor’s “in network” so my options are kind of limited, but I don’t think I can ever see that Doctor again after today!!!

That’s unfortunate, but doesn’t she understand that as reimbursements continually get cut to health care providers by the government (Medicare/Medicaid), and by health insurance companies [to increase profits], some doctors don’t always have the time to be as concerned, and they just aren’t going to perform to the best of their abilities.

Just think about that for a minute. How would you feel if you were asked to work for less money each year?

And here’s another email from some one who wants his insurance company to pay for a visit to an out of network doctor, when his plan doesn’t give him that option.

I was wondering if anyone has advice for an appeal letter to send to our insurance company to appeal our denied request to go see an out of network physician for a second opinion. If possible please also forward my wife on any suggestions or advice as we will be working together to come up with a letter.

I guess he must think he’s in a country like France or the UK where you can see any doctor you choose. But he’s not. He’s in the good old US of A, where we have enough trouble just getting the benefits we’re entitled to, let alone trying to squeeze the for-profit health insurance industry for benefits we’re not entitled to.  GOOD LUCK! (I might also had some of my comments back to him weren’t well received by a few members of the message board.)

And finally, there’s even some religious undertones which go on here. One lady was upset because her cousin, diagnosed with non hodgkins lymphoma refused treatment, and just wanted to die. A lot of the posts were supportive, but this one post got my ire.

The neighbor down the street, at eighty-something had had successful heart surgery and seemed to be on the mend after months of suffering and several hospitalizations. She was diabetic but then suddenly developed kidney failure. She out and out refused dialysis. Wouldn’t discuss it and her conversation amounted to, I’m ready to die. Period. End of story. Her husband and friends’ pleas were ignored. Then in her final two days’ dying in an extended care facility she regretted her choice (told my wife who works there). Rational decisions aren’t everyone’s choices. Sad to say.

Anyone else think this post is contrived, and designed to advance an agenda?

Oh well, like I said, I was bored.

That was a suggestion from Lyndon Baines Johnson’s National Security Advisor, McGeorge Bundy, on what to do in Vietnam, about 6 months into Johnson’s presidency after Kennedy’s assasination.

No matter what your views on the wars in Iraq and Afghanistan, the tapes of LBJ, as presented by Bill Moyers on PBS (part 1 and part 2), sheds tremendous light on the complexities and the struggles LBJ dealt with in deciding the course of action to be taken in Vietnam.

They are TRULY enlightening, to say the least, and even President Obama would do well to listen to them! IMO, it’s a great piece of journalism. Something we could use a lot more of now a days.

Editor’s note: Johnson dismissed that suggestion out of hand, but I just wonder now what would have happened had he not? And I wonder if that same piece of advice might not be such a bad suggestion for putting an end to the wars in Iraq and Afghanistan as well?

Yesterday, I went to see my primary care physician at the VA hospital. But before getting in to see her, I had to see the nurse to take my vitals, and ask me a few questions. The first questions were related to whether I had PTSD. Since I’ve never seen combat that was an easy one to answer.  No!

But then came questions concerning depression, e.g. in the past 2 weeks have I felt depressed, down, not feeling like doing anything?

I snickered at first, not sure how to answer, but then I thought,

Yeah I’m depressed, down, and sometimes don’t feel like doing anything. Why would you even think that wasn’t the case? I’ve got a terminal illness, which I monitor on a monthly basis, waiting for the moment when something changes drastically, for the worse, and I have to start treatment. I may hide it well sometimes, but that doesn’t mean I don’t feel like that most a lot of the time.

Then there’s the fact the company I’ve worked at for the past 20+ years (and definitely in the top 10 of best companies to work for), was just purchased by a MUCH bigger company, and there are already changes taking place which are going to have a big impact, and not necessarily for the better.

And those are just the little things. There’s so much more to be depressed about.

This isn’t the country I remember growing up in. Yeah, maybe with the internet and everything else, we have become more attuned to the divisions in this country and in the world, but I believe it goes much deeper than that.

I hate the way this country has become so divided, i.e. right/left, conservative/liberal, republican/democrat, red state/blue state etc. I hate the fact we have spawned so many derisive and hateful people like Glenn Beck, Sarah Palin and Rush Limbaugh, whose only goals are to promote themselves, and foment divisions and hatred within the country.

I hate the fact that so many people in this country have so little regard for the plight of others, they would sooner cut their own throats then help out someone less fortunate.

I hate the fact our elected representatives have been bought and paid for by big business, and no longer care about what’s best for their constituents and for the country, but only what is in their own self interest (and the interests of the businesses that support them), and how they can ensure their reelection.

Oh, and maybe worst of all, I’ve hardly been getting any riding in on my bike this month, and I still haven’t been able to figure out what is causing that damn clicking on my bike.

But after all that deliberation (about 2 seconds worth), instead of answering the questions truthfully, I chose to lie, and I answered no. It wasn’t a big lie, but I just wasn’t interested in confronting what might be next had I answered truthfully. That might have made me even more depressed.