Insurance woes. Many of us have heard about a “friend of a friend,” or “some guy” who has been well and truly abused by their health insurance company. We all have the same response -- “that’s horrible,” or something to that effect. Luckily, though, most never get the pleasure of dealing with insurance shenanigans first hand. Well, I’m here to tell you that real people do have to deal with health insurance B.S., for lack of a better word, and it can range from being mildly annoying to thoroughly life-changing.
I was diagnosed with Rheumatoid Arthritis when I was nine. In 1987, before compact discs, the PC, and MTV, I was a mere third-grader who, we thought, had simply caught a bad case of the flu. After several weeks of harboring this “flu” without improvement, the doctors began to look for other causes. To cut a two-year story very short, let’s just say that I was diagnosed with something called Juvenile Rheumatoid Arthritis when I was eleven. My mother diligently spent hours upon hours reading and researching the disease at libraries all over – the “Wikipedia” of the real world at the time. Unfortunately, as is still true today, doctors did not have any idea what caused the illness. So, as one of the first serious cases of the disease in my area, my parents and I went from doctor to doctor, agreeing to test after test, just on the off chance one of the procedures would provide some insight into the ailment that was previously unknown. That never happened, though, and I went from a child with Juvenile Rheumatoid Arthritis to an adult with plain old R.A.
Throughout my childhood and early adulthood, I was lucky enough to be covered by what could be called a “Cadillac” insurance plan. I was able to choose my own doctors, purchase experimental medication, and have any procedure performed without pre-authorization. I cannot imagine what would have happened if we had to fight my health insurance company in those uncertain initial years – I could have ended up in a wheelchair. I tell you this because I want you to understand that I have experienced the good side of health insurance as well as the bad, and the difference is striking.
Eventually the Cadillac plan became too expensive to sustain. Because I was officially disabled, I was also automatically enrolled in Medicare. Because Medicare is always the primary insurance, I was basically paying upwards of $12,000 dollars a year for secondary insurance. So I dropped the Cadillac plan and Medicare became my sole insurance carrier.
Now, I have to take this opportunity to tell you that Medicare is one of the best insurance carriers I have ever dealt with – but that classification comes with two corollaries. First, it must be said that I suffer from a disease that is on the Medicare short list for ailments that are allowed a very large amount of leeway when it comes to insurance claims. Second, I am only talking about hospital stays, doctor’s visits, and medical procedure coverage. Prescription coverage is an absolute and utter nightmare.
For those of you who don’t know how Medicare works here is a brief summary. Part A is the hospital coverage, which covers hospital stays and part B is the actual medical insurance, which covers doctor’s visits and the like. Both of those parts pretty much take care of themselves and are more or less painless in their execution. Part D, though, is the prescription coverage, and even understanding it is a Rubik’s Cube of donut holes, external medical insurance companies, and denial appeals.
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