6 ms·

I am assuming you are an American citizen. If you haven't already, you need to: 1) call your Congressperson's local office (not DC) and ask for someone in con

I am assuming you are an American citizen. If you haven't already, you need to: 1) call your Congressperson's local office (not DC) and ask for someone in constituent services who works with health care issues. Do this tomorrow. If your insurance company is denying you any care, and you have a paper trail, they should help. If your Rep can't help, then contact your two Senators' offices. Generally, Reps are much better with this sort of constituent service. 2) call your local Fox affiliate and tell them your story. (November sweeps are coming up, and this is a perfect post-House nighttime news story). 3) put up a web page that has your story, pictures, and easily found contact information for the follow up press stories that will occur. This is your best path to making sure you don't get denied coverage from your insurance company (and it's amazing they haven't found a way to drop you yet) for the benefits that you are entitled to.

ErrantX 17y ago
It seems awful to me that all of that effort is needed just to make sure your not screwed over by the insurance company :( Or is it just the norm and Im not used to it?
- olefoo 17y ago
  Speaking from personal experience, it is the norm. In the US you are completely on your own, and your insurance company is not your friend; no matter how dutiful you were in paying your premiums. If you have a chronic, treatable condition, expect to fight it out with your insurance company 2 to 3 times a year over whether or not they will live up to their contractual obligations. It is my considered opinion that if Obama wanted to lever the healthcare debate around to actual change, the only tool he would need are the RICO statutes. And I don't think his prosecutors would find it difficult to bring cases.
  - ErrantX 17y ago
    Ouch, I cant believe such a basic right is being so abused in your country! Well I did because I was over there a few weeks ago visiting my cousin and she ranted about it - but she is a super-hardline liberal so I obviously took her comments with care (bit of truth, bit of OTT). Sounds like she might have been spot on!
    - youngian 17y ago
      No, haven't you heard? Health insurance in America is the best in the world! Obama only wants to change it because he's a Commie! </sarcasm>
  - yummyfajitas 17y ago
    Perhaps a solution to the problem of chronic, treatable conditions is to make health insurance not pay for them. In short, turn insurance back into insurance (protection against low probability, high cost events).
    - sachinag 17y ago
      Wait, WTF? Isn't getting bitten by SuperTick exactly the sort of low probability, high cost event insurance is for? Just because something is chronic doesn't make it low cost.
      - ErrantX 17y ago
        and also - who else would pay for it?
      - yummyfajitas 17y ago
        I'm not seeing how getting bitten by a supertick is chronic. I was responding to the meta-problem (insurance not paying for chronic conditions), not the OP's specific problem.
        joeyo 17y ago
        The problem isn't the acute supertick bite, but the chronic, expensive condition that arises from it.
        Confusion 17y ago
        It sounds like you work for an insurance company. If you start along this path, they will find an incidental causation for every chronic affliction.
    - rsheridan6 17y ago
      The intersection of chronic, treatable conditions and low probability, high cost events is not empty. You could find a condition with any combination of being chronic, acute, low probability, high probability, low cost, or high cost. What you're really looking for is getting insurance out of covering expected medical expenses, but the problem is that doctors and hospital charge higher prices to the uninsured. I had a medical bill once that was denied by insurance, and the hospital wanted something like $12,000. Later we got the insurance to pay, and the hospital only charged them $2,000 or so. A related problem is that the tax code favors insurance companies by providing a tax break to employers, which is why most Americans get insurance through their employer.
- ars 17y ago
  Most hospitals have a person who's job it is to deal with insurance companies for you. Changing to a public plan isn't going to make it better (since they will still be trying to control costs by not treating unnecessary things). The one thing that will make it better is more integration, but then you have people complaining that the insurance companies are telling doctors what to do. There is no perfect way to both: control costs by challenging doctors on what they bill, and at the same time not making it hard for people to get the services they need.
  - ErrantX 17y ago
    That's interesting. I wasnt directly suggesting it was reason to support a public plan btw. Just that it sounds pretty stinky. I also would add that I think you've got the wrong "problem". control costs by challenging doctors on what they bill, and at the same time not making it hard for people to get the services they need Is never an issue over here [UK] (not just because of the public aspect).
    - ars 17y ago
      I think in the UK the insurance people tell the doctors what to do. But they hide it well, and it doesn't seem to cause a problem. (Or maybe it just doesn't bother the people as much, the US has a more independent culture.) Could a doctor in the UK prescribe an experimental treatment? Could he prescribe it and get insurance to pay for it? I bet not without a fight. Perhaps the difference is that there, the fight is behind the scenes so the patient never knows about it (if it's rejected I bet the doctor never even mentions it as a possible treatment). In the US the insurance belongs to the patient, so it's the patients job to handle them (with help). In the UK it's not so.
      - ErrantX 17y ago
        Could a doctor in the UK prescribe an experimental treatment?Could he prescribe it and get insurance to pay for it? I bet not without a fight. Yes, because insurance doesn't pay for it. You can get experimental treatment on the NHS - I think it is a little more of a hoop to jump through and depends on the actual hospital your at (for example most will insist other forms of medicine have been tried first). Here doctors are a lot less litigatable as individuals; I think that is the main reason health care is better here. Without frivolous lawsuits and insurance companies breathing down their necks.
- Shooter 17y ago
  As an example of how frustrating it is: to get treatment covered by a US insurer for some infections (like, say, Lyme) you usually have to have two different tests that both have positive results, in a specific order. You have to test positive on an initial, fairly inaccurate test...and then you have to follow that result with a positive test on a [relatively] more thorough and accurate test. But some of these (patented) tests are based on just a single species of the organism. (There are a couple hundred species of Borrelia, IIRC, which is the spirochete family that causes Lyme. So, if you don't happen to have that 1 in 2XX species of bacteria, then you will likely not test positive in the exact way they want you to in order to 'earn' treatment.) And the longer you've been infected and the more serious your symptoms, the less likely you are to test positive because your antibody response diminishes over time. "You can't just skip ahead to the more accurate and thorough test now, silly, that's cheating." (?!) If you have a regional strain of bacteria that isn't recognized as a cause of 'Lyme', like 'STARI', then you're probably just out of luck completely. The tests were not even intended for this diagnostic purpose by the CDC, but they are being used that way by insurance companies in order to exclude people from treatment. The tests are meant to be used for statistical tracking purposes only. Oh, and some of the people that are fighting long-term treatment and the development and acceptance of new tests are the very people that hold the patents on the existing tests. There are already more accurate tests available, but insurance companies will simply not accept them.
- amalcon 17y ago
  It is the norm. I pay twice as much for my insurance as I would for identical coverage from the HMO branch of the same insurer, simply to make it harder for them to deny payment. This is totally worth it, but not everyone can afford to do this. I still have to fight them at least two or three times a year over coverage of something.
- bokchoi 17y ago
  Just yesterday my insurance company decided that a routine physical and cholesterol blood test was not covered. After calling them up, they assure me that they will cover preventative care but somehow this physical exam is not preventative. Their definition of preventative clearly is not the normal definition and is meant to screw with people. Most likely it is a billing error or some such. So I'll spend the next few weeks calling various people and harassing them. It wouldn't be so bad if this wasn't the norm. Every time I visit the dentist or doctor, something comes up from insurance. Then I waste a week or a month fighting the insurance company for the most inane things. Now imagine if you couldn't speak English or didn't have the time to make these calls.
  - ErrantX 17y ago
    This is what convinces me the system is utterly broken for you guys. I mean you can understand fuss and screw ups with expensive, complex or unique treatments. But when you have a faff just to go for a dental check up..... Here I book my appointment, turn up, get 10 minutes or so check up and polish and then pay £16. No fuss or drama. If you need to go back within the month it is free (on the £16 payment) too. Bargain.
Shooter 17y ago
There are literally thousands of people with similar stories that are more articulate - and less bitter and angry - than I am. And the media is slowly picking up on these issues. http://underourskin.com/blog/ http://underourskin.com/blog/ recently mentioned, for example, the change in stance of Good Morning America's medical correspondent over the course of a year. Enough people are getting sick and raising a ruckus that there are finally some changes being made for the better and there is starting to be a more open dialogue. There is still a long way to go, though. I'm more of a behind-the-scenes type person. I have worked in trying to get legislation passed on these issues, and I've donated time and money to some of the organizations that try to help (legal defense funds for physicians, research studies, physician education grants, public education and outreach, etc.) My insurance company has tried to drop me, BTW, repeatedly. It's a constant battle. My wife, fortunately, is a Director at a major research hospital and she has a great deal of experience in battling insurance companies. And I'm very fortunate in being able to cover the cost of what they will not cover, at least for now. Many are not so lucky. Some states have enacted legislation to force insurers to meet minimum standards for these diseases, but most states let insurers get away with writing people off or even making it impossible for people to get diagnosed initially.
- brandnewlow 17y ago
  "My wife, fortunately, is a Director at a major research hospital" Holy cow, you're fortunate (all things considered).
- sachinag 17y ago
  I think you misunderstood me - I'm not talking about policy/legislative changes. I'm talking about having their office fight, as your wife does, with the insurance companies on your behalf. This is what "constituent services" does.
  - Shooter 17y ago
    No, I understood. And I really appreciate your intentions. I just addressed the things that were most relevant to me in more detail. I do have congressman fight insurance companies on my behalf. But, I'm very lucky because of my wife and finances at this point in my life (finally), so I think I can have a bigger impact by thinking outside of my own problems a bit. One of the people that was very helpful to me in finding treatment (and her sister) are in the documentary I mention, for example, and she died from Lyme complications after filming because she was denied adequate treatment for so long. I know others that have died due to Lyme and associated vector-borne diseases. (A celebrity reference for the HN crowd: Mary McDonnell of Donnie Darko and Battlestar Galactica is an activist in fighting Lyme and associated tick diseases that I occasionally see because she had a family member die of Lyme.) In sum, people are dying - and wishing they could die - because of these diseases, so I also wanted to address other actions I have taken and that others can also take.
mattmaroon 17y ago
I don't know if you're familiar with Fox, but they're not running any story that suggests healthcare needs government intervention.
- amalcon 17y ago
  The local news is not always as blatantly partisan as the big network news from those guys.
- defen 17y ago
  I think he was suggesting that they could do a human-interest story about a real-life Dr. House (to take advantage of sweeps), with Shooter as an example of someone whom no one else could diagnose properly. They could completely leave out the bit about the insurance companies if they were so inclined.
- johnnybgoode 17y ago
  This is false. You must not be familiar with the way local Fox affiliates work. Local news != Fox News Channel. Sorry if this was just a partisan joke and I missed the humor.

ErrantX 17y ago

It seems awful to me that all of that effort is needed just to make sure your not screwed over by the insurance company :( Or is it just the norm and Im not used to it?

olefoo 17y ago
Speaking from personal experience, it is the norm. In the US you are completely on your own, and your insurance company is not your friend; no matter how dutiful you were in paying your premiums. If you have a chronic, treatable condition, expect to fight it out with your insurance company 2 to 3 times a year over whether or not they will live up to their contractual obligations. It is my considered opinion that if Obama wanted to lever the healthcare debate around to actual change, the only tool he would need are the RICO statutes. And I don't think his prosecutors would find it difficult to bring cases.
- ErrantX 17y ago
  Ouch, I cant believe such a basic right is being so abused in your country! Well I did because I was over there a few weeks ago visiting my cousin and she ranted about it - but she is a super-hardline liberal so I obviously took her comments with care (bit of truth, bit of OTT). Sounds like she might have been spot on!
  - youngian 17y ago
    No, haven't you heard? Health insurance in America is the best in the world! Obama only wants to change it because he's a Commie! </sarcasm>
- yummyfajitas 17y ago
  Perhaps a solution to the problem of chronic, treatable conditions is to make health insurance not pay for them. In short, turn insurance back into insurance (protection against low probability, high cost events).
  - sachinag 17y ago
    Wait, WTF? Isn't getting bitten by SuperTick exactly the sort of low probability, high cost event insurance is for? Just because something is chronic doesn't make it low cost.
    - ErrantX 17y ago
      and also - who else would pay for it?
    - yummyfajitas 17y ago
      I'm not seeing how getting bitten by a supertick is chronic. I was responding to the meta-problem (insurance not paying for chronic conditions), not the OP's specific problem.
      - joeyo 17y ago
        The problem isn't the acute supertick bite, but the chronic, expensive condition that arises from it.
      - Confusion 17y ago
        It sounds like you work for an insurance company. If you start along this path, they will find an incidental causation for every chronic affliction.
  - rsheridan6 17y ago
    The intersection of chronic, treatable conditions and low probability, high cost events is not empty. You could find a condition with any combination of being chronic, acute, low probability, high probability, low cost, or high cost. What you're really looking for is getting insurance out of covering expected medical expenses, but the problem is that doctors and hospital charge higher prices to the uninsured. I had a medical bill once that was denied by insurance, and the hospital wanted something like $12,000. Later we got the insurance to pay, and the hospital only charged them $2,000 or so. A related problem is that the tax code favors insurance companies by providing a tax break to employers, which is why most Americans get insurance through their employer.
ars 17y ago
Most hospitals have a person who's job it is to deal with insurance companies for you. Changing to a public plan isn't going to make it better (since they will still be trying to control costs by not treating unnecessary things). The one thing that will make it better is more integration, but then you have people complaining that the insurance companies are telling doctors what to do. There is no perfect way to both: control costs by challenging doctors on what they bill, and at the same time not making it hard for people to get the services they need.
- ErrantX 17y ago
  That's interesting. I wasnt directly suggesting it was reason to support a public plan btw. Just that it sounds pretty stinky. I also would add that I think you've got the wrong "problem". control costs by challenging doctors on what they bill, and at the same time not making it hard for people to get the services they need Is never an issue over here [UK] (not just because of the public aspect).
  - ars 17y ago
    I think in the UK the insurance people tell the doctors what to do. But they hide it well, and it doesn't seem to cause a problem. (Or maybe it just doesn't bother the people as much, the US has a more independent culture.) Could a doctor in the UK prescribe an experimental treatment? Could he prescribe it and get insurance to pay for it? I bet not without a fight. Perhaps the difference is that there, the fight is behind the scenes so the patient never knows about it (if it's rejected I bet the doctor never even mentions it as a possible treatment). In the US the insurance belongs to the patient, so it's the patients job to handle them (with help). In the UK it's not so.
    - ErrantX 17y ago
      Could a doctor in the UK prescribe an experimental treatment?Could he prescribe it and get insurance to pay for it? I bet not without a fight. Yes, because insurance doesn't pay for it. You can get experimental treatment on the NHS - I think it is a little more of a hoop to jump through and depends on the actual hospital your at (for example most will insist other forms of medicine have been tried first). Here doctors are a lot less litigatable as individuals; I think that is the main reason health care is better here. Without frivolous lawsuits and insurance companies breathing down their necks.
Shooter 17y ago
As an example of how frustrating it is: to get treatment covered by a US insurer for some infections (like, say, Lyme) you usually have to have two different tests that both have positive results, in a specific order. You have to test positive on an initial, fairly inaccurate test...and then you have to follow that result with a positive test on a [relatively] more thorough and accurate test. But some of these (patented) tests are based on just a single species of the organism. (There are a couple hundred species of Borrelia, IIRC, which is the spirochete family that causes Lyme. So, if you don't happen to have that 1 in 2XX species of bacteria, then you will likely not test positive in the exact way they want you to in order to 'earn' treatment.) And the longer you've been infected and the more serious your symptoms, the less likely you are to test positive because your antibody response diminishes over time. "You can't just skip ahead to the more accurate and thorough test now, silly, that's cheating." (?!) If you have a regional strain of bacteria that isn't recognized as a cause of 'Lyme', like 'STARI', then you're probably just out of luck completely. The tests were not even intended for this diagnostic purpose by the CDC, but they are being used that way by insurance companies in order to exclude people from treatment. The tests are meant to be used for statistical tracking purposes only. Oh, and some of the people that are fighting long-term treatment and the development and acceptance of new tests are the very people that hold the patents on the existing tests. There are already more accurate tests available, but insurance companies will simply not accept them.
amalcon 17y ago
It is the norm. I pay twice as much for my insurance as I would for identical coverage from the HMO branch of the same insurer, simply to make it harder for them to deny payment. This is totally worth it, but not everyone can afford to do this. I still have to fight them at least two or three times a year over coverage of something.
bokchoi 17y ago
Just yesterday my insurance company decided that a routine physical and cholesterol blood test was not covered. After calling them up, they assure me that they will cover preventative care but somehow this physical exam is not preventative. Their definition of preventative clearly is not the normal definition and is meant to screw with people. Most likely it is a billing error or some such. So I'll spend the next few weeks calling various people and harassing them. It wouldn't be so bad if this wasn't the norm. Every time I visit the dentist or doctor, something comes up from insurance. Then I waste a week or a month fighting the insurance company for the most inane things. Now imagine if you couldn't speak English or didn't have the time to make these calls.
- ErrantX 17y ago
  This is what convinces me the system is utterly broken for you guys. I mean you can understand fuss and screw ups with expensive, complex or unique treatments. But when you have a faff just to go for a dental check up..... Here I book my appointment, turn up, get 10 minutes or so check up and polish and then pay £16. No fuss or drama. If you need to go back within the month it is free (on the £16 payment) too. Bargain.

Shooter 17y ago

There are literally thousands of people with similar stories that are more articulate - and less bitter and angry - than I am. And the media is slowly picking up on these issues. http://underourskin.com/blog/ http://underourskin.com/blog/ recently mentioned, for example, the change in stance of Good Morning America's medical correspondent over the course of a year. Enough people are getting sick and raising a ruckus that there are finally some changes being made for the better and there is starting to be a more open dialogue. There is still a long way to go, though. I'm more of a behind-the-scenes type person. I have worked in trying to get legislation passed on these issues, and I've donated time and money to some of the organizations that try to help (legal defense funds for physicians, research studies, physician education grants, public education and outreach, etc.) My insurance company has tried to drop me, BTW, repeatedly. It's a constant battle. My wife, fortunately, is a Director at a major research hospital and she has a great deal of experience in battling insurance companies. And I'm very fortunate in being able to cover the cost of what they will not cover, at least for now. Many are not so lucky. Some states have enacted legislation to force insurers to meet minimum standards for these diseases, but most states let insurers get away with writing people off or even making it impossible for people to get diagnosed initially.

brandnewlow 17y ago
"My wife, fortunately, is a Director at a major research hospital" Holy cow, you're fortunate (all things considered).
sachinag 17y ago
I think you misunderstood me - I'm not talking about policy/legislative changes. I'm talking about having their office fight, as your wife does, with the insurance companies on your behalf. This is what "constituent services" does.
- Shooter 17y ago
  No, I understood. And I really appreciate your intentions. I just addressed the things that were most relevant to me in more detail. I do have congressman fight insurance companies on my behalf. But, I'm very lucky because of my wife and finances at this point in my life (finally), so I think I can have a bigger impact by thinking outside of my own problems a bit. One of the people that was very helpful to me in finding treatment (and her sister) are in the documentary I mention, for example, and she died from Lyme complications after filming because she was denied adequate treatment for so long. I know others that have died due to Lyme and associated vector-borne diseases. (A celebrity reference for the HN crowd: Mary McDonnell of Donnie Darko and Battlestar Galactica is an activist in fighting Lyme and associated tick diseases that I occasionally see because she had a family member die of Lyme.) In sum, people are dying - and wishing they could die - because of these diseases, so I also wanted to address other actions I have taken and that others can also take.

mattmaroon 17y ago

I don't know if you're familiar with Fox, but they're not running any story that suggests healthcare needs government intervention.

amalcon 17y ago
The local news is not always as blatantly partisan as the big network news from those guys.
defen 17y ago
I think he was suggesting that they could do a human-interest story about a real-life Dr. House (to take advantage of sweeps), with Shooter as an example of someone whom no one else could diagnose properly. They could completely leave out the bit about the insurance companies if they were so inclined.
johnnybgoode 17y ago
This is false. You must not be familiar with the way local Fox affiliates work. Local news != Fox News Channel. Sorry if this was just a partisan joke and I missed the humor.