Remember when the employee of Caremark, the prescription distributor my insurance company contracts with, told me they weren’t sure they wanted the liability of selling me my prescribed Humira? At a time it looked like nothing else would keep me alive? I wanted to say to them, all drugs have side effects and if you can’t handle that simple fact of life, what on earth are you doing in this business? And why do you have any say whatsoever? You’re just a supplier. My insurance has (FINALLY!) approved that Humira. It is approved by the FDA for the disease I have. Send me the flippin’ med, fer cryin’ out loud, since it’s one I cannot pick up at a drugstore and cannot do anything about on my own.
And we all know how that one went. Nada, despite frantic phone calls from us, from my doctor, even from that Caremark employee’s secretary responding to me by walking around the floor trying to find where that woman went so she would finally take my call again and do the right thing.
And then my readers saved the day by bombarding them with messages till they not only caved when the weekend was over, but they actually grovelled. Which was a little too satisfying for my own good.
So. On the Sunday of Memorial Day weekend, as I’ve written here, I was in Urgent Care again in great pain with a new flare, and one of the things the doctor I saw did was to prescribe me Zofran.
When my Crohn’s flares, I barf. I never did once during all my pregnancies and I used to pride myself on having an iron stomach. Shows you what I knew. So. It is somewhat unusual for Crohn’s to cause barfing, and I can assure anybody that thank you, I’d prefer to be normal on that one. But all the iron-stomach thinking and determination I’ve tried gets me nowhere these days: in the hospital, they had to keep me on two different high-powered IV anti-nausea meds at a time pretty constantly.
I could draw you graphic pictures of what I do on Phenargan, the entry-level med. Let’s not.
Based on all that, the Urgent Care doctor prescribed me Zofran instead, and rightfully so.
Which the insurance company denied. And not only denied, but since it was a holiday weekend, they had nobody on staff to even begin to appeal it to to get me through the long weekend. The doctor filling in for my Dr. R. reiterated to them a few days later my need for that med; with my very low blood pressure, barfing is an emergency and I need to have access to it.
I got a letter Saturday. Not from Blue Cross, my insurer, but from Caremark, who, like I say, they contract with, and who my local pharmacy had to get the okay from. And I quote:
“The request was denied for the following reason:
The patient is not receiving moderate to severely emetogenic chemotherapy, total body irradiation or fractionated abdominal irradiation. The patient is not less than 18 years of age with a diagnosis of gastroenteritis and dehydration.”
I don’t have cancer so go ahead and barf. Nice.
And we wonder why the insurance companies don’t want the accountability that would be a natural part of the competition of having people having a choice of a government plan vs. them? Right now, their only accountability is done legislative piece by piece, state by state, as outraged people get the one part of medical neglect they’ve been subjected to fixed by the demand of the law, while other parts wait for someone to suffer loudly enough.
My friend and hero Marnie took on a quarter million dollars in medical debt to adopt her kids, because at the time insurance companies were allowed to deny coverage to babies till they’d proven they were healthy their first month and forever if they weren’t. That loophole was so egregious as to spark a Federal law outlawing it, too late for her.
We need a better system. We need the will to do it. I’m not one demanding a single payer, but I do say, and loudly, that the insurance companies MUST be held accountable. And the only way to do that, short of lawsuits that drive up healthcare costs and enrich the lawyers, is if they have true competition, which they do not now. You know why they’re fighting so hard against the government providing an optional plan. They’d have to change.