For Profit Health Care is the Real Crisis

The real health crisis in the US isn’t opiates, it’s for profit health care. J and I pay around $600 a month for our health insurance. When I went to the doctor July 15th to follow up on my tailbone, I had to wonder why I pay this monthly premium. My insurance had made the decision that the X-Ray done at that appointment was unnecessary. This means they didn’t pay for it or the visit cost leaving me a $1,000 bill for that appointment. And because that appointment wasn’t necessary, my follow up wasn’t necessary and they had already decided that appointment wouldn’t be paid for. My doctor marked it as a refill appointment instead of a follow up. And as we discussed what I should do for my tailbone pain and the fact that every so often, I get a pins and needles sensation in my foot, I was told they had hoped to do an injection at my follow up, but guess what, insurance wouldn’t pay for it. How does this tie into opiates? Only in the US can pharmaceutical companies pay doctors to prescribe medications and only in the US can health insurance companies decide what course of treatment you can and cannot get, without paying for it out of pocket. And all of this is possible because our health care is a for profit system.

Here’s the kicker, we pay all this money to our insurance companies for our premiums and then get penalized when we have to use it. For instance, J doesn’t go to the doctor unless he just can’t deal with it anymore. His gallbladder made him sick for 2 years before I decided he no longer had an option, he had to see a doctor for it. He’d had surgery a month before on his shoulder. A surgery that was medically necessary and met his deductible for the year. However, he was still billed several hundred for his gallbladder removal surgery, because insurance wasn’t sure that 2 inch gallstones constituted the need for surgery. Before 2018, the last time he used his insurance was when he got Influenza A in December 2015. Our premiums are double or triple in some cases of his coworkers, because I have a chronic disease that requires frequent trips to the doctors along with occasionally tests.

But treatment for my tailbone, which is not CRPS related (we don’t think) is unnecessary, despite the fact that it increases the daily pain levels in my hip (the tailbone is connected to the hip bone, the hip bone’s connected to the… well you get the picture). I was asked if I wanted to go ahead and do the injections and set up a payment plan. They’re $2,500. I don’t have savings, because I have to put out large sums of money on doctors when my insurance decides not to cover something. So no, I’ll just go home and suffer, thanks.

And I am not in the minority. One thing I’ve learned from talking to other people with CRPS, is that very few of them have money in savings for the same reasons I don’t: it’s difficult to keep a job (in my case write a book) without being properly medicated, and god forbid they enter a flare, or need something extra and most of them show up at doctor’s appointments and suddenly have to lay out more money than expected because their health insurance didn’t cover something and we are all terrified to owe our pain management doctors money. I gave them full payment, even though I didn’t really have it, because I know that come October or December when I need my next set of refills, my bill will be higher than it was today and I may not be able to get treatment because I owe my doctor so much. And here’s the kicker, the money I put out this morning, didn’t go towards my $2,000 deductible, because the X-Rays were considered unnecessary. Just like if I had agreed to do injections today and pay for them, that $2,500 wouldn’t go towards my deductible, meaning I’d still have $2,000 I’d have to pay out of pocket between now and November.

Also, while my insurance doesn’t pay for my pain medication, they did send me a form I had to fill out about why my doctor had taken me off Lyrica. Want to know why? Pfizer pays the insurance company to allow me to get Lyrica. Here’s how that works; Pfizer – the maker of Lyrica – pays my insurance company to allow me to get Lyrica. My insurance company doesn’t pass those dollars on to me, I’m still required to lay out the $400 a month for the prescription. Before the Opiate Crisis, pharmaceutical companies paid doctors, hospitals, and insurance companies for every opiate prescription that was written and filled. This is the big reason why the Opiate Crisis exists. Ditto on the problems we are now having with Lyrica and neurontin. And it is only possible in places where healthcare equals huge profits, like the US. It is illegal to give a kickback to a doctor in Canada or the UK for writing a prescription.

If I were to keep that $600 a month and use it towards my medical care and just get rid of health insurance, I’m not sure I wouldn’t save money. My 2018 medical costs (premiums, plus what the insurance company didn’t pay) was $10,000, prescriptions, co-pays, co-insurance, etc). My insurance only put out $4,500 on me…. And even though ketamine during my gallbladder surgery was medically necessary and all the information and paperwork was sent to them regarding why it was medically necessary, they didn’t pay for it. I spoke to the anesthesiologist six times about it. It was submitted nine times and rejected every time. Eventually, the anesthesiologist and I came to an agreement where I paid only half of what I owed for the Ketamine I received to prevent my disease from spreading to somewhere like the nerves surrounding my liver or my skin in that area. Half was $1,000.

Our system sucks… And before you talk about how it takes months to get into the doctor in Canada or the UK, emergency treatment is easy to come by and if you live in a city, you could wait months to see a doctor under our current system. My cousin lives in Springfield, Missouri – population 300,000. If she needs to see her doctor, she has to call months in advance to get that appointment, urgent care and walk in clinics take care of her “I think I have the flu” needs, just like in Canada and the UK.

One thought on “For Profit Health Care is the Real Crisis

  1. I’ve talked with some people in Canada and someone from the UK. All of them said that the whole waiting months to see a doctor is a bunch of bull. It’s the same as it is here or sometimes faster. Insurance ugg – years ago I had a doctor tell me he wasn’t allowed to practice medicine anymore. A bunch of insurance bigwigs, who know nothing about medicine, tell him what he can and can’t do. Lastly, would an insurance savings account work for you guys. (I don’t remember the number or know if they’re even still allowed, but I think you guys would definitely come out better.)

    Liked by 1 person

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