Pharmaceutical Companies are as Evil as Insurance Companies

Today we went in to have the orthopedic surgeon begin injections into Hubby’s knees. He is in constant pain when he walks. Active all this life, he now has to hobble at the grocery store, limp with the doggies in the park, and we have permanent handicapped tags on the car.

We have investigated total knee replacement, but Hubby is not yet ready for another hospital stay. He’s afraid. The last one, 7 days in ICU, 10 days total, stole his strength. Because the knees are now so painful he has been unable to exercise his way back to his former physical level. His legs, always muscular and strong, emerged from the hospital as toothpicks. He’s been reduced to a tenth of a mile hobble around the park; then he sits on the old folks’ bench and lets the dogs roam at will. He can’t play with them anymore on their daily walks.

We tried cortisone injections to reduce swelling and pain but they produced no effect. Today’s shots are a visco-supplementation therapy that involves injecting a clear gel-like substance directly into the knee joint. A series of injections in each knee help to restore some of the lubrication lost by damaged cartilage. An injection is given as one shot into the knee joint each week for three weeks.

The doctor tells us that usually people who respond to this form of treatment will experience some improvement for six to ten months. An injection series can be repeated every six months as needed. This method of therapy is used for people who have not benefited from less invasive therapies such as lifestyle modification, physiotherapy, and oral medications.

The cost for one treatment cycle of Synvisc® (three weekly injections) into ONE knee is over $800 – that covers only the drug and not the doctor’s services for the injections. We’re doing both knees. Because these shots are so expensive, it takes up to a month to get approval from the insurance company. We could have started treatment two weeks ago when we had an appointment with the doctor to hear about the results of Hubby’s MRI, but the insurance approval had not yet been granted.

I went with Hubby to get the shot – one to each knee. It was a very simple procedure. The actual injection site was marked with the doctor’s fingernail imprint – he held his finger on the knee until he had an indentation – and then the shot was given. Hubby experienced little to no pain. He was advised not to jog for a couple of days, but we laughed at what was clearly a moot point.

I began researching Synvisc® on-line when we got home, just to see what the prognosis was for Hubby feeling much better in about three weeks. He’s got a 50% chance, which is pretty good considering the state his knees are in. But what got me was that in Canada we could have bought the series of Synvisc® (all three shots) for $315.

Then the mail arrived. In it was a bill to us for $100 – a sum that wasn’t covered by Hubby’s MRI to prove that his knees didn’t have tumors, just arthritis. The MRI cost $755, we paid $35 at the visit, and now we owe another hundred bucks.

I’m so disgusted. We were always told that because we had a democratic system of free trade we were protected from this type of chicanery. Instead, we’ve become victims of greed and price gouging – and the middle class American is going broke if this keeps up.

Being Happy

It’s odd being happy. Oh, this isn’t the “utter elation every moment of the day” happy, but I am happy. This is more than content. For many years, in my “business” life, I was content. Moments of great happiness occurred, but mostly, I what I felt was contentment with my life.

This year, and especially this summer, I’ve felt happy. This is a deep down appreciation of just how good my life has become. I have recognition that I’m blessed with many precious things. I know what isn’t perfect about my life, but I also know that when balancing the good against the bad, I am extremely fortunate right now.

Maybe it takes a whole heap of pretty dreadful things, all of which we survived, to trigger recognition of what happiness is when you finally come out the other end. Last year, 2006, from April to August, life was pretty dire for us. Hubby’s health, my employment, and all the uncertainty that both problems were causing made me feel that life was skidding out of control. When I read what I wrote about last year, I can feel the deep dread I was experiencing at that time. It’s almost more than I can handle, even today.

This summer, however, has been really special, maybe the best one of my adult life. I did what I wanted to do. Oh, sure, I didn’t do everything my heart desires. I didn’t see Venice and ride with Hubby on the Grand Canal. In fact, we never left town. The top shelves of the kitchen cabinets haven’t been touched – and I haven’t cleaned the living room since . . . well, let’s not go there. I haven’t written a single lesson plan for the fall. But what got done was productive and beneficial for both the house and our lives. I didn’t stress myself out over what managed to get accomplished on our “to do” list. I’m not upset over what we didn’t get done. There’s time. What a blessing it is to be able to say “there’s time.”

Next week I start back to school, not on an every day basis, but a workshop here and there until we start in earnest in two weeks. Tomorrow Hubby begins his series of knee injections. Tuesday I start major dental work. Friday I help out a friend. Workshops are Wednesday and Thursday, then again on the 30^th and 31^st. I’m secure in that I’m going back to a job I like – and that I’m really good at. I’m going to work with people I basically respect. My salary is more than acceptable and my benefits are decent.

I sit back and look at my life, just as it is today, and know that I’m happy. How could you ask for more than that? The dogs are healthy and frisky. The house is still standing. Hubby is puttering about; finding things to do that entertain him. He’s not as happy as I am, but he’s still in recovery mode. I hope one day he, too, can realize just how good we really have it.

Last year I wondered whether the glass was half full or half empty. This year I think the glass is full, if not exactly over-flowing. How precious it is to feel happy for an extended period of time, to know that things are going good, and that no matter what the future holds, I will have this time to look back on and cherish. I feel happy. That’s a really important statement to be able to make. I feel really happy.

Moore’s Message

After spending two weeks straightening out my own insurance fiasco, we spend this hot Saturday afternoon in July at the movies watching Sicko.

Without belaboring the message, which definitely needs belaboring in my humble opinion, the movie is very good. Moore has managed to be instructional and entertaining. He is less pedantic in this movie than in previous ones. Your heart strings are tugged but the movie is not overloaded with misery.

The worst scene for me took place right here in my home town at the Catholic mega-hospital St. Joseph’s. A nurse, who worked there, had her husband denied coverage by the hospital’s insurance. When they appealed the decision they were told that a bone marrow transplant was “experimental” even though the man had a perfect match and donor in his youngest brother. Within three weeks the husband and father of a small child was dead. The nurse was eloquent about the plight the hospital had let her suffer and understood clearly that the powers that be had no remorse about their decision.

The movie was shown in a smaller theater at the local 20 metroplex. Nearly all the seats were filled. Hubby said to me, “Looks like this is the crowd that should be interested in this topic,” so I looked around me. The great majority of the audience was over 60 and certainly looked to be the perfect Republican voter – well groomed, well fed, well dressed, and very, very white. Ten minutes into the film the audience was cheering on Michael Moore and groaning audibly over the decisions made by Richard Nixon and George W. The references to Hillary Clinton were even well received.

Now I’m wondering if a time of change is actually taking hold of this country. Is it possible that we are taking Moore’s message to heart: in a country that prides itself on being the leader of the modern world, how can we let so many hundreds of thousands suffer needlessly because we refuse to offer an acceptable health care program to all our citizens? Can we continue to let insurance companies with limitless pockets dictate our health care?

The four countries that Moore examines which offer nationalized health care are Canada, Great Britain, France, and Cuba. The scenes from France made me, for the first time in my life, wonder what it would be like to live outside our borders.

After I quit teaching in 1990 Hubby and I were without health care coverage for 14 of the 17 years I worked as an independent contractor. All our medical bills and all our prescriptions were paid out of pocket. Coverage was simply too expensive. Now, though, since Hubby is over 70 and I’m working for a school district, we both have what is considered more than adequate coverage. Moore’s movie is about folks like us today who have coverage. Even though we now have full health care insurance, we are at extreme risk of losing everything if we face a catastrophic illness. Last year, Hubby’s aneurysm ended up costing over $300,000 – for a ten day siege. That’s not counting all the bills racked up since then. Next week he’s having gel injected into his seriously damaged knees – and we’ve learned that the series of six shots, three in each knee, cost in the thousands. We have insurance which is covering the majority of the cost – but not ALL of the cost. We are lucky but we aren’t immune. Our prescriptions, our doctor visits, our hospital visits all take a percentage of our income. Right now we can cover those expenses. Right now . . .but if we face more problems as we age, then maybe we won’t be able to. Right now our insurance is providing coverage, if we fight the system for it. How long can we keep up the fight?

The young, the old, and way too many people in-between are suffering terribly in this great country because the insurance industry is all about profit and money and greed. It’s time to put a stop to it. As decent human beings, as a nation who claims to lead the world in democracy – we MUST step up and offer a sensible national insurance plan to all our citizens. No American should suffer so an executive at Aetna, Humana, Blue Cross, etc., can take home the big bonus.

If you haven’t seen it yet, take the time and check out Sicko. You’ll be glad you did.

A Year And Counting

Teaching last year was wonderful but it completely absorbed me and ate up my meager reserves of physical strength. Add into the mix that I had to start graduate school all over again (second Masters) -- and Blogging became one of those activities I needed to ignore.

The grad course for the fall semester of 2006 was online but the prof wanted paper after paper, I think to prove that we actually were reading the text book. I had to take an extension into February to get all the writing done. Somehow I was talked into taking two courses for the spring semester of 2007. One course was manageable and only required I attend once a week for three hours and write a couple of reasonable-in-length papers. The second course, a practicum, never met but the final paper was incredibly complicated. Again, I had to take an extension and just got it turned in finally, this week -- 24 pages of paper, 30 pages of addendum, and two Excel graphs showing 195 hours of work.

Meanwhile, Hubby continued to recuperate. Church work went forward. Friends fell by the way-side. By the time summer arrived -- for my school district in mid-May -- I was in dire need of a time for rejuvenation and renewal.

This summer has been wonderful. We did things slowly, very, very slowly. Hubby has always wanted to sell "junk" on e-bay, so we cleaned cupboards and closets and bookshelves and we began listing things. It's not as difficult as we initially supposed. A lot of things sold and a lot of things didn't so we gave a bunch away to the local charity stores.

Hubby met with the orthopedic surgeon and they evaluated his knees. I found a new doctor, hopefully one I will like this time around (the last one was just a little too into strange off-the-wall medications). I also began a series of dental work that revolves around a broken back molar.

Now summer is winding down. Next week Hubby starts the knee injections -- three in each knee for three succeeding weeks. I start the root canal on August 1 which will lead to a crown. I'm going to a two-day literacy workshop next week and the following week a two-day workshop to learn to use the Mac laptop the district gave me at the end of school.

I didn't take any grad courses this summer, but I'll start again in late August. School itself starts up August 3rd with teacher workshops. I wasn't ready last week for summer to end, but this week I'm beginning to think it will be okay. I'm rested. Most of what I wanted to accomplish has at least had dents made in them.

Last year was wonderful, though full of ups and downs, traumas and victories. This summer has been quiet and peaceful. I think about what it was like for me this time last year. My world has turned 180 degrees from that place. I'm ready to move forward, to enjoy this time of success in my life. Things are very, very good.

Hopefully, that means I'll be back here writing once again. We shall see . . .

Nothing Like a Rant to Restart Blogging

So people started writing me about their experiences with insurance companies, which are clearly -- along with the pharmaceuticals – the Satans of the modern age in the United States.

Here’s an example from a friend who works at a lab:

I wish that I could tell you that your story is one that I have not heard before. Given that I work directly with insurance companies I often see problems for patients where the insurance has denied erroneously and we, XXX Lab, not knowing that the denial is erroneous send the patient a bill. Patient needless to say is incredibly upset that they get a bill from XXX Lab and think that we are the screwiest company ever (kind of like your Walgreen's experience but unfortunately, we don't have a storefront that people come in to) and then refuse to believe that the issue is with their insurance company. I often call the insurance company with the patient to hear the insurance company tell us that they denied the claim - sometimes they acknowledge their error and sometimes they don't.

There are some definite issues with the system - there is not really a consequence for insurances when they deny claims in error - it actually is in their benefit as they get to hold on to their money longer and think how many patients don't complain and just pay the bill.....or never pay the bill and expect someone like my company to re-file to the insurance (which takes time and money for us....the insurance company doesn't care....) ...not sure who did your blood work but, if it was XXX Lab and you have any problems, please feel free to let me know.

And from a teacher in another state who is simply fed up with bureaucrats in general:

I truly understand about Humana. A good reason why your system should get rid of them. The thing that blows my mind most is the time and level of frustration it takes to deal with every freakin’ bureaucracy. I'm having something similar right now with XXX School District trying to get reimbursed to the tune of $1800 for a trip I took to the international reading conference in May. The trip had to be approved by the superintendent and now they're telling me my reimbursement needs to be approved by him also. Mind you – XXX School District isn't even paying for it!!!!! It's part of a grant.

Go figure. So much time wasted by everybody on this SHIT!

This came from a friend in another state who is self-employed:

doG! Milly, what a mess. Sounds like (name of state) Care. My sister is covered by it and what you have gone through she has as well...at least three times. Hopefully this will not happened again. But make sure you have anti-anxiety meds on hand for the next renewal.

This came from a scientist working in a lab in a local hospital:

OK, here is what XXX Insurance Company did (usually we have great response from them). I still think XXX is the best insurance we have ever dealt with. They canceled out insurance for the last week of our old fiscal year policy (last week of June). Everyone had to call the prescription coverage part to have them reinstate us for meds needed that week. What a bummer. No one realizes the time and frustration this puts on the American population (at least no one who can change it).

Another teacher in a district just across the state line wrote:

I could not agree with you more about Humana being the company from h e l l !!!

Numerous issues over the years, mostly in regard to my migraine medications and what is or isn't covered, or what coverage has now changed after nine years. I HATE HUMANA!!

A friend from California who has retired wrote:

I deal with insurance companies every day since I do all the insurance billing for the acupuncturist at the clinic. Humana is not the only company from hell, believe me. We joke at the office that to be hired by an insurance company the #1 requirement is that you have no common sense, can't think for yourself and are as dumb as a bat There are a couple of smaller companies that are really good - but all the big guns are impossible to deal with. Fortunately the patient did not die for want of medication while trying to unravel their mess.

Update on Insurance Issue

So -- we are at 11 days now and counting -- with no insurance that can be verified except by my employer.

Everyone swears that I have insurance and that it is active -- and yes, please go get your prescriptions. Except I show up at the pharmacy and they laugh at me! "You have no insurance!" they chortle with glee.

I hate Humana! Hate! Hate! Hate!

I wonder if I'll ever get off this merry-go-round.

Insurance - Humana is a Cold-Hearted Company!

)(@#$)(#!!!!!!!

For the past week I have been battling with Humana -- and USD #000 (my district) over insurance. God, what a screw up!

I enrolled in April. For USD #000 each year you have to re-enroll to have continued health coverage. You can do it online and everybody in my building had trouble with the on-line enrollment process. I had to communicate with the district's insurance coordinator five times before I got it -- partly because I was adding Will into the mix for some of the insurance and I was adding dental to my own policy (I had the broken tooth and knew how expensive that would be).

So, got enrolled, got back notification I had enrolled.

In USD #000 coverage ends June 30th and new coverage begins July 1.

I saw my new (and hopefully liked) doctor last week of June. Got all the new scripts, except for one that was determined I needed AFTER the blood work came back. They sent that one in the mail -- but doctoring in the new millennium has new techniques and so when I realized I had only a 30 day script, I e-mailed the office to get a 90 day script because Humana gives a month's free if you fill in big numbers. The doctor's office called in to my pharmacy the new script -- and I went to pick it up.

Which is when I discovered I had no insurance coverage, according to Walgreen’s. To be honest, I was initially ticked at Walgreen’s. Of course, I had coverage. But after the second visit, when I was inside (not the pick-window) and they called Humana, I heard Humana announce that my coverage had been terminated.

Not -- non-renewed -- T E R M I N A T E D!!!!!!

I flew home and called USD #000. All I could think was that I had somehow flubbed the enrollment process and . . . but no. USD #000 confirmed I had medical, dental, vision, and life insurance. So, I said to USD #000 -- what's the deal? They suggested I call Humana and on their part, they would look into the situation.

Oh, lord. Humana is the company from hell. It's this huge stone wall one can't get through. It took me forever to figure out how to get a real live person on the phone. I logged into the web site, using my password, and was immediately notified that I had "NO ACTIVE COVERAGE." When I finally got a person on the phone, I got disconnected. Eventually I got another live person and was told, "No, you have no coverage. It was terminated June 30th. So sorry. Can't help you. Goodbye."

So began phone calls and numerous e-mails -- and as I investigated further, I discovered that my doctor's bill of $225 for the last week of June had also been rejected, because -- Humana couldn't verify who my insurance coverage had been with previously (it was Humana, f*ckers, the construction company had Humana and when I changed employment they simply kept my same number and transferred the policy).

Meanwhile I couldn't get the medication. One day goes by. I continually check on line to see if the situation has been rectified. USD #000 notifies me they are checking -- and they provide multiple e-mails to prove they are trying to find out what happened. Two days go by. Three days go by. Etc.

Eventually, USD #000 notifies me that Humana has notified them they had an error loading "some" employees into their system. USD #000 demands a complete audit of the system. Humana discovers that approximately a dozen were load incorrectly and I'm one of the dozen. But now EVERYTHING is fixed and I have full coverage.

Back to Walgreen’s to get medication. Nope, no coverage. Walgreen’s calls Humana and they say they've never heard of me. We call USD #000 and alert them. More folks get involved.

I send more irate e-mails: "This is what's wrong with our health care system in the United States."

More days go by.

Finally, USD #000 notifies me that they think everything is resolved. On-line it now shows me active on the Humana site. Because I had complained in every single e-mail that my doctor's claim has been denied -- I find that it is now paid (big sigh of relief -- who wants their brand new doctor to think they've lied about insurance?). Walgreen's calls to say they have my prescription ready for pick-up.

And this morning, I get the coup de grace -- an e-mail (finally -- this is the ONLY communication I've had with them) from Humana that says, "We understand you have complained about a break in your coverage. We have reviewed your files and we show that you have had coverage from 09/01/06 through 06/30/07 and under the new policy from 07/01/07 to 06/30/08. This is continuous coverage. Please do not complain again when everything has been perfect for you and we have never made a mistake. You are an idiot." -- or something that read like that.

I thought I would bust a gasket!

In retrospect, USD #000 was wonderful. They were responsive and calm and persistent. They communicated with me daily. I was VERY pleased.

Humana on the other hand is the company from H E L L and if you can avoid ever having their insurance, please do so. Tell everyone! Humana sucks the BIG ONE!

Imagine . . .the nerve of implying that I'm the idiot . . .