Normally, I chat about children's literature in one form or another. On occasion, I toss in a post about my trials through mommydom and wifyhood. There's even been a few that fetch to tickle your funny bone or inspire you.
Welcome to a new meme created by me, for me, and about me. Honest, it's not as self-absorbed as it sounds. I have in issue, a gripe, I'd like to share with you.
Normally, I keep inspirations here on a positive note. But this is a subject that has been gnawing at my sides for a while now and I'm wondering if some of you have similar thoughts and feelings on the subject.
Health care.
According to Dictionary.com, the term health care means:
"The field concerned with the maintenance or restoration of the health of the body or mind."
Ever have an issue with your health insurance company? Of course you have. We all have. Like any oiled machine--note I refrained from using the word 'well'--parts wear and systems need updating. Understandable, right?
Sure.
I mean absolutely no insult to anyone utilizing state or federal programs. We take care of our own, and I'm 100% good with that. What frustrates me is this: No matter how loyal you are to your insurance company, your doctors, or your hospitals, everyone is out for themselves. Period.
Approximately five years into our marriage, my husband was diagnosed with Sleep Apnea (AP-ne-ah). According to the Mayo Clinic, sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly and you feel tired even after a full night's sleep. There are two main types of sleep apnea - Obstructive sleep apnea (the more common form that occurs when throat muscles relax) and Central sleep apnea (which occurs when your brain doesn't send proper signals to the muscles that control breathing).
Of course, there is a lot more to it, such as pauses in breathing ranging from a few seconds to as long as a minute. This obviously puts stress and strain on vital organs and affects the patient's waking hours as well. For the purpose of this article, I'll stop there. But you can check with sites such as National Heart, Lung, and Blood Institute or American Sleep Apnea Associationfor more information.
My husband went under two separate sleep studies, which lead to a prescribed BiPAP machine (Bilevel Positive Airway Pressure). A CPAP machine (Continuous Positive Airway Pressure machine) can also be used in treatment. Let me reiterate the machine was prescribed by a doctor - a physician who specialized in sleep apnea. My hubby used the machine for a while. Then, like the stubborn man he can be, he tired of it.
Fast-forward to about six months ago. His sleeping patterns and snoring had gotten so bad, neither of us had slept in months. He finally returned to the doctor for sleep apnea treatment. It had been so long since his last sleep study, he needed to undergo another one. Okay, whatever. Let's get this done so his body stops aging more quickly because of his lack of breathing/oxygen while sleeping. And, or more selfishly on my part, so we can sleep and function.
HOWEVER ... when his doctor submitted the necessary test to our insurance company they deny her request for his testing. Why you ask?
Because, in their opinion - His condition is not life-threatening enough and unless he shows other signs such as a stroke they are denying her request. The insurance company wants him to have a freaking STROKE before they'll let him have the test, which he's had twice in the past - both of which came back positive and his condition has only worsened over the years???
What is wrong with our health care system? We have been good citizens. We work hard. Raise our children well. Help others. Pay our bills - including the overpriced insurance company premiums. And this is what we get in return. Bah...
So I barked, which encouraged my husband to bark at his doctor and the insurance company.
And guess what?
He had the test.
And guess what?
Ding, ding, ding...it's sleep apnea, again. Go figure.
Obama's health care blah, blah, blah ... is suppose to bridge this gap for those of us Americans considered The Middle Class. (key in booming music)
I would very much appreciate you chiming in, here. Tell me what you think. Share your healthcare experiences (or nightmares). This inquiring writer wants to know.
Gosh, seriously sorry this happened. I've heard of similar cases of the insurance denying things like this. It's disheartening. My premiums are so high, it's insane.
The system is a mess. Part of the problem is all the regulation they place on doctors and nurses to make sure they give good care. Humph. We're so busy jumping through (mostly stupid, unnecessary) hoops, we have little time for our patients at all. And don't get me started on computer charting... takes me three times as long as on paper--and that's for a normal, uncomplicated case. *shakes head*
You are right on, there. I have Raynaud's Syndrome, so I have a specialist I see once a year. When I began seeing her two years ago, the nurse would bring me in, ask the appropriate questions, and then I'd see my doctor. Recently, the 'hospital' enacted changes which put another middle man between me and my doctor. I had to not only see the nurse, but a PA and basically tell this poor PA the exact thing I told the nurse except the PA had no prior knowledge of my health problem. This just made the process take forever, because I had to explain everything to her. My appointment, which usually takes approximately 30 minutes took almost 2 hours. I can't see how that was cost efficient. And I could tell my doctor was irritated by the whole change - she had no control over it.
Obama care is not to blame for this. Insurance companies have been denying treatments for longer than he's been in office. My beef? Those of us who have no insurance and can't get any. Yes. That would be me. Why don't I have health insurance? Because I'm so poor I qualify for medicaid but in Maine our special governor refused to expand medicaid leaving me - and thousands like me - up the proverbial creek without health insurance.
That said our health system is flawed, was flawed, and will continue to be flawed until we have socialized medicine, in my opinion. And there's no reason it has to be exactly like the other countries who have socialized medicine. We can make it better...well, we could if our stupid politicians were more concerned with getting something done than remaining at odds with another. But that's another story...
Anyhow, just my two cents. And I'm glad you barked!
See, this is a perfect example of how messed up the system is. I do not claim to know the answers to fix it, but we really need to figure something out to help those who can't get it and those of us who do have it yet are siphoned to death. When my husband was with his former company (who we're still paying under COBRA for), our healthcare plan cost just over 700 a month out of our pocket. I can't remember what the company paid in. That didn't include dental, which was an extra 200 monthly. When he left and we started paying through COBRA, we opted for a higher deductible to try and keep the monthly cost down. Shoot, we have four kids who are actually living. Then, we had a few unexpected surgeries, which meant we had to pay 5,000 per family member first. Holy ... we have medical bills up the ying-yang, right now. And to have the insurance company rather my husband have a stroke first is just stupid. How cost effective would that be with him out of work and us having four kids? like I said, the system is broken. I wish the politicians and heads of insurance companies would listen to us instead of the dollar bill.
I've seen socialized medicine in action. It ain't pretty. If you think private insurance is a nightmare, just wait until the government really takes it over. Oh, wait! I think they already have and we're starting to find out what that's all about. There are other government operated business that are in something of a mess. I think the post office is a great example. Fortunately, they don't dabble in health issues. Sorry about what's happening about your husband's situation, Sheri. Hope you can find coverage somehow.
I think a lot of the fault with health care is with the insurance companies. They want to line their pockets with as much money as they can and not hand it out to people who need it for their procedures. Of course, the hospitals charge much more than necessary too. If they were non-profit, they'd probably be much better and cheaper. It's a screwed up system. Glad they were able to test him again. Sleep apnea is not something to mess around with.
Do you have insurance through Obamacare? We're the only first-world country with insurance through our employer. It's archaic. Unfortunately, the initial plan for the healthcare and what got compromised means things aren't going to be all that different. I still think everyone needs protection. It's worked extremely well in MA for years, and we haven't become socialists.
No. We have it through my husband's former employer - we're still under COBRA, right now, but looking into new insurance for our car dealership. I agree that everyone needs coverage, and I don't claim to know the answer to the issues. I just would like fair coverage, especially for those of us who pay up the wazoo.
That's terrible. I agree with Alex on the Obamacare. Though with my income level, Obamacare may be more expensive than some of the other options when I get laid off and have to purchase insurance.
Welcome to my world. I work in a family practice clinic. Many times, every single day, we work our bodies and souls to exhaustion to do what is right by the patient, only to hear that their insurance company won't pay for the tests or treatments that our doctors know are absolutely necessary to their good health. I probably hear your sleep apnea story once a month. Once every single month! I don't know if it helps at all to know that you are not alone.
The doctor I work for said that he heard the statistic that of all of the profits from all of the companies in the US, 49% of them are made by insurance companies. I probably should try to find that statistic somewhere to verify it. But from what I see the insurance companies doing every single day to every single one of their customers, I would believe it.
What I don't get is why the American citizens put up with this. I don't have any answers either, but something definitely needs to be done.
The new evaluation system being forced on teachers is horrendous -- judging us based on standardized test scores. But what's even more horrifying is that this same "data-based" evaluation is being forced on doctors. Hospitals are being denied funding and insurance if patients return with the same problem within a certain period: If the treatment doesn't work, or if the patient doesn't take his medicine when he goes home, or if the patient ignores all the doctor's advice and goes back to the bad habits that caused the condition in the first place -- and lands back in the hospital, THE HOSPITAL IS PUNISHED.
This is the worst thing I have ever heard, and I swear, seems a giant conspiracy to prevent people getting the care they need.
I've been blessed with a wonderful pediatrician for my kids. When my son was diagnosed with epilepsy at the age of two we went through the insurance and got an old school doctor who believed in nothing but meds. But these meds have so many damned side effects that we were concerned. We had a second opinion--same network--and the dr. knew the first dr and didn't want to change opinions. Our Peds dr finally said screw it and took the hit by sending us to an out-of-network doctor. Apparently the doctors have to pay something when they send you out of network. Anyways, since my son only had one seizure in a year this dr said it wasn't worth putting him on meds. He may outgrow it. and guess what. he did. I don't know what to say. The middle class folks are screwed. I hope everything works out for you and your husband.
Thanks so much. And I hear you on the side effects of meds and such. My oldest has ADHD. He was diagnosed when it was first becoming 'labelized'. lol We said no to meds for the first five years and took the behavioral modification approach. He did have to go on meds for about ten months in fifth grade. He just couldn't sit still in school. He's fine, now, and at the time, our insurance company didn't give us any problems.
Congrats to you for being a true advocate for your child.
I'm so sorry you and your family are going through this, Sheri. I'm afraid it's only going to get worse. And wait until you're over 70. I have insurance through the retired teachers' organization and it used to be good and I think it is better than a lot of insurance. Or it was. Now, well... let's just say I'm not getting the tests for my heart murmur I've always had in the past. Doctor? System? I don't know. Hope your hubby and family stay healthy.
Whoa, Sheri, You REALLY opened up a can of worms on this subject.... I AM SO WITH YOU ON THIS!
When I was HIT on the lakefront last year by an insane speed cyclist, I was FLATTENED. MY hit spilt open from the puncture of that jerks helmet. 14 stitches there, 4 on my lip, tons of abrasions and a broken wrist.
I can not TELL YOU how much this ass cost me. My insurance only covered so much. The PRICES the doctors and hospital charge was INSANE... $600.00 bucks for a cast! INSANE... SO my issuance paid a whopping fifty bucks. SO guess what I got the BILL! And a nervous twitch. After months of MORE bills coming in, this "accident" cost me out of pocket close to THREE GRAND! Because the insurance I have only covers "So much".... I not only blame the insurance companies I think the HOSPITALS AND DOCTORS are REALLY to BLAME! They have gotten COMPLETELY OUT OF CONTROL! Our government NEEDS to STEP In and SET A PRICING STANDARD. NO EXCEPTION. This way the insurance companies WILL HAVE TO PAY because it is the STANDARD rate in this country.... ENOUGH SAID!
Ahhhh. That feels so much better. LOL. As you can see, I am right behind you on this! Thanks for inviting me to RANT! LOL.
Wow, sounds horrible, especially since you should not have paid a cent, the cyclist who hit you should have paid the whole bill.
But, anyway, most doctors, clinics and hospital do not have a say in what they charge, a lot of doctors don't have a clue what they are charging, they are employees like anyone else, working for a large corporation which is nothing but a big business making money on people's misfortunes. Or that's how it is with my employer and most of the medical groups in my state.
I just had to say it because the doctor I have worked with for the last 14 years is in the same boat that I am, and that his patients are in. (Side note: our employer sent my doctor to collections over a $25 bill.)
Gosh, this is just as horrible. Whoa... You are so right when you say healthcare is big business. Kind of stinks. I understand needing to make a profit, the economy, etc... But I think it's gone way beyond that.
So frustrating. I'm sorry people are going through this. I have no health issues, but have issues with my coverage. It keeps getting shoddier, the network gets smaller, and it gets more expensive.
That's very true. I think the majority of us can only pay 'more' for so much longer. I know my family can't afford much more of an increase/decrease in benefits.
That is so bad! I feel for him. That said, my son who came back from China (teaching there) got excellent coverage from Obamacare, including free dental! In China, healthcare is pretty much free. Somehting to be said for faux communism. (Faux, because they have Starbucks, and fancy malls too).
In England they have universal healthcare. My understanding is that for some things it takes a long time to get assistance on, but you can pay extra fees and get things done faster if you have the money to do it.
My husband has a cpac. He sleeps a LOT better and I sleep with him. Every once and a while it is on his nose funny and is noisy, so I go to the other room. But it really helped. I've heard that dentists can make a device that helps with sleep apnea too.
Wishing your husband all the best - my sister suffers from such a condition but is much better now although it's taken awhile. We feel blessed with the UK's NHS system with all its flaws and imperfections it continues and remains an essential lifeblood in providing healthcare for all. I hope that more nations will find it in their hearts and souls to see that such a system is probably a good way to start in ensuring basic medical help is provided. Take care x
Gosh, this almost sounds like a prayer. I love it! Thank you so much for the encouragement. It's not my intent to sound ungrateful for what we do have, but I just go so stinking frustrated. I really appreciate your words.
*head bang* That's stupid. My hubby and his brother both have it and both of their different insurance carriers cover it. Grrr
ReplyDeleteGosh, seriously sorry this happened. I've heard of similar cases of the insurance denying things like this. It's disheartening. My premiums are so high, it's insane.
ReplyDeleteThe system is a mess. Part of the problem is all the regulation they place on doctors and nurses to make sure they give good care. Humph. We're so busy jumping through (mostly stupid, unnecessary) hoops, we have little time for our patients at all. And don't get me started on computer charting... takes me three times as long as on paper--and that's for a normal, uncomplicated case. *shakes head*
ReplyDeleteYou are right on, there. I have Raynaud's Syndrome, so I have a specialist I see once a year. When I began seeing her two years ago, the nurse would bring me in, ask the appropriate questions, and then I'd see my doctor. Recently, the 'hospital' enacted changes which put another middle man between me and my doctor. I had to not only see the nurse, but a PA and basically tell this poor PA the exact thing I told the nurse except the PA had no prior knowledge of my health problem. This just made the process take forever, because I had to explain everything to her. My appointment, which usually takes approximately 30 minutes took almost 2 hours. I can't see how that was cost efficient. And I could tell my doctor was irritated by the whole change - she had no control over it.
DeleteObama care is not to blame for this. Insurance companies have been denying treatments for longer than he's been in office. My beef? Those of us who have no insurance and can't get any. Yes. That would be me. Why don't I have health insurance? Because I'm so poor I qualify for medicaid but in Maine our special governor refused to expand medicaid leaving me - and thousands like me - up the proverbial creek without health insurance.
ReplyDeleteThat said our health system is flawed, was flawed, and will continue to be flawed until we have socialized medicine, in my opinion. And there's no reason it has to be exactly like the other countries who have socialized medicine. We can make it better...well, we could if our stupid politicians were more concerned with getting something done than remaining at odds with another. But that's another story...
Anyhow, just my two cents. And I'm glad you barked!
See, this is a perfect example of how messed up the system is. I do not claim to know the answers to fix it, but we really need to figure something out to help those who can't get it and those of us who do have it yet are siphoned to death. When my husband was with his former company (who we're still paying under COBRA for), our healthcare plan cost just over 700 a month out of our pocket. I can't remember what the company paid in. That didn't include dental, which was an extra 200 monthly. When he left and we started paying through COBRA, we opted for a higher deductible to try and keep the monthly cost down. Shoot, we have four kids who are actually living. Then, we had a few unexpected surgeries, which meant we had to pay 5,000 per family member first. Holy ... we have medical bills up the ying-yang, right now. And to have the insurance company rather my husband have a stroke first is just stupid. How cost effective would that be with him out of work and us having four kids? like I said, the system is broken. I wish the politicians and heads of insurance companies would listen to us instead of the dollar bill.
DeleteI've seen socialized medicine in action. It ain't pretty. If you think private insurance is a nightmare, just wait until the government really takes it over. Oh, wait! I think they already have and we're starting to find out what that's all about. There are other government operated business that are in something of a mess. I think the post office is a great example. Fortunately, they don't dabble in health issues. Sorry about what's happening about your husband's situation, Sheri. Hope you can find coverage somehow.
ReplyDeleteI think a lot of the fault with health care is with the insurance companies. They want to line their pockets with as much money as they can and not hand it out to people who need it for their procedures. Of course, the hospitals charge much more than necessary too. If they were non-profit, they'd probably be much better and cheaper. It's a screwed up system. Glad they were able to test him again. Sleep apnea is not something to mess around with.
ReplyDeleteI agree with Lee - socialized medicine is not the answer. It's sad though when you pay your dues and can't get the care you need.
ReplyDeleteDo you have insurance through Obamacare? We're the only first-world country with insurance through our employer. It's archaic. Unfortunately, the initial plan for the healthcare and what got compromised means things aren't going to be all that different. I still think everyone needs protection. It's worked extremely well in MA for years, and we haven't become socialists.
ReplyDeleteNo. We have it through my husband's former employer - we're still under COBRA, right now, but looking into new insurance for our car dealership. I agree that everyone needs coverage, and I don't claim to know the answer to the issues. I just would like fair coverage, especially for those of us who pay up the wazoo.
DeleteThat is just insane. Imagine how bad it would've been with Obamacare. Glad your husband had the test done.
ReplyDeleteThat's terrible. I agree with Alex on the Obamacare. Though with my income level, Obamacare may be more expensive than some of the other options when I get laid off and have to purchase insurance.
ReplyDeleteSheri, this is terrible! Unfortunately, I think this is only the beginning of what's to come. Glad your hubby is getting the care he needs.
ReplyDeleteWelcome to my world. I work in a family practice clinic. Many times, every single day, we work our bodies and souls to exhaustion to do what is right by the patient, only to hear that their insurance company won't pay for the tests or treatments that our doctors know are absolutely necessary to their good health. I probably hear your sleep apnea story once a month. Once every single month! I don't know if it helps at all to know that you are not alone.
ReplyDeleteThe doctor I work for said that he heard the statistic that of all of the profits from all of the companies in the US, 49% of them are made by insurance companies. I probably should try to find that statistic somewhere to verify it. But from what I see the insurance companies doing every single day to every single one of their customers, I would believe it.
What I don't get is why the American citizens put up with this. I don't have any answers either, but something definitely needs to be done.
The new evaluation system being forced on teachers is horrendous -- judging us based on standardized test scores. But what's even more horrifying is that this same "data-based" evaluation is being forced on doctors. Hospitals are being denied funding and insurance if patients return with the same problem within a certain period: If the treatment doesn't work, or if the patient doesn't take his medicine when he goes home, or if the patient ignores all the doctor's advice and goes back to the bad habits that caused the condition in the first place -- and lands back in the hospital, THE HOSPITAL IS PUNISHED.
ReplyDeleteThis is the worst thing I have ever heard, and I swear, seems a giant conspiracy to prevent people getting the care they need.
I've been blessed with a wonderful pediatrician for my kids. When my son was diagnosed with epilepsy at the age of two we went through the insurance and got an old school doctor who believed in nothing but meds. But these meds have so many damned side effects that we were concerned. We had a second opinion--same network--and the dr. knew the first dr and didn't want to change opinions. Our Peds dr finally said screw it and took the hit by sending us to an out-of-network doctor. Apparently the doctors have to pay something when they send you out of network. Anyways, since my son only had one seizure in a year this dr said it wasn't worth putting him on meds. He may outgrow it. and guess what. he did. I don't know what to say. The middle class folks are screwed. I hope everything works out for you and your husband.
ReplyDeleteThanks so much. And I hear you on the side effects of meds and such. My oldest has ADHD. He was diagnosed when it was first becoming 'labelized'. lol We said no to meds for the first five years and took the behavioral modification approach. He did have to go on meds for about ten months in fifth grade. He just couldn't sit still in school. He's fine, now, and at the time, our insurance company didn't give us any problems.
DeleteCongrats to you for being a true advocate for your child.
I'm so sorry you and your family are going through this, Sheri. I'm afraid it's only going to get worse. And wait until you're over 70. I have insurance through the retired teachers' organization and it used to be good and I think it is better than a lot of insurance. Or it was. Now, well... let's just say I'm not getting the tests for my heart murmur I've always had in the past. Doctor? System? I don't know. Hope your hubby and family stay healthy.
ReplyDeleteWhoa, Sheri, You REALLY opened up a can of worms on this subject.... I AM SO WITH YOU ON THIS!
ReplyDeleteWhen I was HIT on the lakefront last year by an insane speed cyclist, I was FLATTENED. MY hit spilt open from the puncture of that jerks helmet. 14 stitches there, 4 on my lip, tons of abrasions and a broken wrist.
I can not TELL YOU how much this ass cost me. My insurance only covered so much. The PRICES the doctors and hospital charge was INSANE... $600.00 bucks for a cast! INSANE... SO my issuance paid a whopping fifty bucks. SO guess what I got the BILL! And a nervous twitch. After months of MORE bills coming in, this "accident" cost me out of pocket close to THREE GRAND! Because the insurance I have only covers "So much".... I not only blame the insurance companies I think the HOSPITALS AND DOCTORS are REALLY to BLAME! They have gotten COMPLETELY OUT OF CONTROL! Our government NEEDS to STEP In and SET A PRICING STANDARD. NO EXCEPTION. This way the insurance companies WILL HAVE TO PAY because it is the STANDARD rate in this country.... ENOUGH SAID!
Ahhhh. That feels so much better. LOL. As you can see, I am right behind you on this! Thanks for inviting me to RANT! LOL.
Wow, sounds horrible, especially since you should not have paid a cent, the cyclist who hit you should have paid the whole bill.
DeleteBut, anyway, most doctors, clinics and hospital do not have a say in what they charge, a lot of doctors don't have a clue what they are charging, they are employees like anyone else, working for a large corporation which is nothing but a big business making money on people's misfortunes. Or that's how it is with my employer and most of the medical groups in my state.
I just had to say it because the doctor I have worked with for the last 14 years is in the same boat that I am, and that his patients are in. (Side note: our employer sent my doctor to collections over a $25 bill.)
Gosh, this is just as horrible. Whoa... You are so right when you say healthcare is big business. Kind of stinks. I understand needing to make a profit, the economy, etc... But I think it's gone way beyond that.
DeleteSo frustrating. I'm sorry people are going through this. I have no health issues, but have issues with my coverage. It keeps getting shoddier, the network gets smaller, and it gets more expensive.
ReplyDeleteThat's very true. I think the majority of us can only pay 'more' for so much longer. I know my family can't afford much more of an increase/decrease in benefits.
DeleteThat is so bad! I feel for him. That said, my son who came back from China (teaching there) got excellent coverage from Obamacare, including free dental! In China, healthcare is pretty much free. Somehting to be said for faux communism. (Faux, because they have Starbucks, and fancy malls too).
ReplyDeleteWow, Catherine. I had no idea healthcare was like that in China. Hmm....makes you wonder.
DeleteIn England they have universal healthcare. My understanding is that for some things it takes a long time to get assistance on, but you can pay extra fees and get things done faster if you have the money to do it.
ReplyDeleteMy husband has a cpac. He sleeps a LOT better and I sleep with him. Every once and a while it is on his nose funny and is noisy, so I go to the other room. But it really helped. I've heard that dentists can make a device that helps with sleep apnea too.
Wishing your husband all the best - my sister suffers from such a condition but is much better now although it's taken awhile. We feel blessed with the UK's NHS system with all its flaws and imperfections it continues and remains an essential lifeblood in providing healthcare for all. I hope that more nations will find it in their hearts and souls to see that such a system is probably a good way to start in ensuring basic medical help is provided. Take care
ReplyDeletex
Gosh, this almost sounds like a prayer. I love it! Thank you so much for the encouragement. It's not my intent to sound ungrateful for what we do have, but I just go so stinking frustrated. I really appreciate your words.
DeleteThanks!