My spouse struggled with a medical condition for years and was lucky to finally get a prescription for something that actually resolved the problem. The medication was expensive ($1000+ a month), but since we literally tried everything else, insurance would “let” it be covered.
Then I lost my job and had to move over to a new company’s insurance plan. And they won’t cover it.
The fact that your employment in the US determines what medical care you can get is absolutely bonkers.
A medication being more expensive usually indicates rarity. This means the instance of required coverage by insurance companies is also rare. The fact any medication, needed to mitigate the risk of simply being born, might not be covered by “insurance” is bonkers.
I think we need to start a new industry to take it to insurance companies every time they deny coverage. Bury them in complaints and legal actions. Go so hard on every case that they give in immediately upon seeing the letterhead.
I knew a guy with AIDS that had some pills to take like once a month I think that were around that price and also struggled with coverage. I didn’t think AIDS was considered rare.
It’s important to keep in mind that this rarity is often artificial scarcity by the pharmaceutical companies. There are some conditions which are rare, but have treatments that have been available for decades now with generics on the market for years. They simply don’t produce much of those meds, even though it’s cheap to do so, in order to artificially inflate the market price.
Insurers are complicit in this scheme because they don’t push back on this practice at all. Without single payer, we have no negotiating force to get pharmaceuticals to produce drugs in an affordable way, so they can manipulate the market however they please. It’s absolutely depraved.
They did that to prevent people from being able to shop for insurance. They promote capitalism, but they suppress competition which is, in theory, supposed to be part of a “healthy” capitalist economy.
The ACA helped a tiny bit, but it didn’t go nearly far enough. And then they tried a zillion times to revoke even that.
It’s never been about healthcare, it’s always been about making a small number of people very wealthy.
We do stings in restaurants (for servering underagers) all the time. The fines are significant for the server and the restaurant. I wish they would do stings on mechanics, dentists, and most importantly health care. Wrongfully denied claims should be devastating to the company.
Oh yeah dentists for sure. The dentist who removed my wisdom teeth was a total quack. He did it in two sessions, used novocaine even though I told him it didn’t work well on me, and actually crushed a tooth to get it out. And yes, I felt the pain of him crushing a tooth. We should have sued him.
This was when I was 19. I’m 46 now. A few months ago, I had a terrible pain back where my wisdom teeth were and it got worse and worse. I have some nerve issues, so scheduling a dentist is a big deal right now because I need to be totally out. So we scheduled it, but a few days later, a little sliver of tooth from the space where he crushed the wisdom tooth worked its way out and the pain stopped.
The fact that whether or not I get medical care is almost completely determined by whatever insurance company I have at any given time is so depressing.
I have thankfully been pretty healthy in my life but the few times I’ve actually needed help I have been told to go fuck myself pretty much every time by my insurance and since I’m not a millionaire I can’t afford anything that’s not covered. Don’t even get me started on the Russian roulette at the doctor’s office where anything can cost seemingly any amount at any time and no one has any damn clue until the bill’s arrived.
So whether or not I need the help really doesn’t matter at the end of the day most times. All that matters is if the insurance company is feeling nice or not.
My doctor diagnosed me with a b-12 deficiency. Something easily fixed with a shot she prescribed.
The pharmacist looked at me like I was a drug addict when I asked where the needle for the injection was when I picked up the scrip. “Just have the doctor do it”.
Fee for randomly showing up to my doctor to get the shot? $0
Fee for getting the shot done when I was actively at a scheduled check up? $130
I take an oral supplement instead now that’s not quite as effective.
Go to your local co-op or tractor supply, or order online. We always have hundreds stocked here on the farm for the animals, and they’re cheaper and literally the same thing as the stuff used for humans, usually from the same companies and factories.
Inb4 someone makes a joke about Horse Dewormer, or Fish antibiotics because they’re “better than that”.
Needles are legal over the counter in my state as they should be. But I’ve had so many pharmacists pull shit about me buying them. Like first of all motherfucker you just saw me buy a vial of estradiol, but even if you didn’t I know I’d rather addicts shoot up with new needles on a purely selfish basis of it prevents disease from spreading. Anyways I buy online in bulk from a medical supplier now, it’s just easier
Remember all the hysteria over “death panels” during the ACA debates? Fooled you, they were already here, invented by insurance companies.
The insurance companies use computer algorithms to deny claims and most people won’t fight it.
Most people can’t fight it. Fighting a claim, depending on insurance, requires multiple different Doctors recommending the same thing. Sometimes the insurance requires prior steps taken that are unavailable to individuals (I was required to take antibiotic that I’m allergic to before a surgery). Getting into a specialist can take months, and the costs of seeing a specialist are not often covered at all (goes towards deductible), and unless you live in or near a city you may not be able to find specialists you don’t need to get a hotel to see (travel expenses and time off work are not covered). Not to mention, if fighting a denied claim rolls over to the next year, everything starts over, even if you have the same insurance it’s considered a new policy because it’s a new year.
Unless you have unlimited time and money, fighting a denied claim is pretty difficult and goes nowhere fast. That’s how the system was designed.
