Written by Daniel P. Malito on March 29, 2011
Medical insurance. To some, all these two words signify is a cost that results in a bit less salary, or a backup plan in case any of those “what ifs” actually happen. To others, it means a political cause to rally for or against. To a few of us, though, medical insurance can be a godsend or a source of stress and worry. Either way, it’s a necessity. Anyone who suffers from chronic illness can tell you the value of an accommodating insurance company, or the headache of a stingy provider.
Since youth, I was fortunate enough to be covered under my father’s insurance plan. Even after he retired, I was able to retain the coverage because I was categorized as disabled. Thinking back, I wonder what I would have done if the coverage I had was not an option. More than likely, I would have had to find my own plan, and my parents would have had to pay for it out of their own pockets. For me, medical insurance coverage is as much of a basic need as eating or breathing. Without it, I would be wheelchair-bound, if I was here at all. Thankfully, not only was I covered, but the policy my family belonged to paid for many procedures, medicines, and items, that would normally be refused for payment. My insurance company was extremely accommodating, and for over fifteen years I enjoyed the benefits of having a “Cadillac” coverage policy.
Now, though, I find myself in an unfamiliar situation. Beginning this year, my primary medical insurance carrier changed to Medicare. Due to my disability, the part A, B, and D coverage that the government provides became the main entity responsible for my medical costs. My previous insurance company became my secondary carrier. I know this sounds confusing, but at the heart of the matter is the fact that my medications are now paid for by a company whose main goal is to cut costs.
At first, the transition was really not too much of a hassle. In fact, I remarked to a friend how surprised I was that my cross over to government insurance was going so smoothly. Little did I know I would be eating my words soon enough. As a Rheumatoid Arthritis patient for almost 25 years, the real joints I have left are not in the best shape, to put it mildly. On the more severe days, the inflammation and disease activity sends twangs of pain coursing up and down my arms and legs. To combat this, there are only two remedies – joint replacement or narcotic drug therapy. I am trying to hold off on joint replacement as long as possible due to the fact that artificial joints only provide 90% (or less) of the range of motion of their authentic counterparts. This leaves me with the second option – pain medication. After years of experimenting with every narcotic drug on the market in several combinations, a regimen was found that eliminated a significant amount of my pain. Not all of it, mind you – I was informed very early on that eliminating all of my pain was not a realistic goal. I was given enough medication to provide relief enough to have an acceptable quality of life.
Understandably, the amount of pain medication that I require is substantial. It was enough to make any pharmacist do a double take, but it is prescribed by a neurologist in good standing at a reputable hospital. My old insurance carrier understood this, and never gave me a problem when I filled the extremely expensive prescription. Now that I am using Medicare as my primary, though, they immediately prevented me from filling my script.
When I realized that I was in danger of losing my pain medication, my first instinct was panic, since not only would I be in pain, but I would suffer withdrawal as well. Pushing the panic aside, I read the letter of denial from the insurance carrier, and appealed the decision. Almost everyone I spoke with assured me that once the provider saw that I had been taking this medication for years and that I was under the care of a world-renowned neurologist, they would approve the medication. Everyone was wrong. When I got the second letter of denial, it informed me that the maximum amount the company would allow was one-third of my current dosage. One-third. One out of three pills. The letter was signed by a doctor who cited “safety concerns” as the reason for denial. It seems to me that the only unsafe action in all of this was to take away two-thirds of my narcotics overnight. A doctor who did not have the insurance company’s interests above all else would realize that. Unfortunately, this final denial left me with a serious dilemma. With only days left of my current prescription, I had to figure out a plan, and fast. I immediately called my neurologist and he was able to squeeze me in the next day. We discussed the issue, and until I can appeal the insurance company’s decision in front of an administrative law judge, my doctor prescribed me an alternate medicine in order to supplement the narcotics that the insurance provider agreed to pay for. Unhappily, the medicine I am using to fill-in for the missing pills makes me drowsy, forgetful, and is generally less effective than what I am used to.
So, as you can see, medical insurance can be a delight or a nightmare, but no matter what, it is an integral part of any chronically ill person’s life. Having to fight for the medications I need to live my life is a new experience for me, but like any other hurdle, I will overcome it. Medical expenses will always be the number one cost in my life, and it’s the same for most who suffer on a daily basis. Medical coverage has been a non-issue for the first half of my life, but it looks like the second half will not be as care-free.