Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week.<p>Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”.<p>Made me realize this whole country is broken and those at the top are morally bankrupt.
Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process:<p>- What did the insurer expect to happen, in order for this person to keep getting their medicine?<p>- Why did those things not happen?<p>- Whose job was it to make sure those things happened?<p>- Did that person know it was their job?<p>- ...etc.<p>I get that it was about prior authorization, but whose job was it to make sure the prior authorization happened? Why didn't that person do it in a timely fashion? Why isn't there an understanding within the insurer's system that Type 1 Diabetes is a life-long condition and not something that will just go away when the insulin runs out?<p>Was there a "happy path" here or does a scenario like this invariably degenerate into a scramble involving dozens of calls and day-destroying last-minute errands?
Health Insurance is a political scam of epic proportions. There is no indemnity involved. It is not real insurance. You don't use insurance to pay a monthly bill, you have it for black swan events. Nor should insulin be 1000/mo, on paper or otherwise.<p>The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't hurt themselves and need care).
Price aside, the biggest problem with American health care system is the administrative black hole at every stage.<p>Wife was on some serious (and expensive) medical treatment. After many months, the medical provider was at the final stages of the treatment. As usual, the provider needs insurance approval for arcane codes that constitute that segment of the treatment.<p>Get this, the medical provider applies for approval using a FAX. There is no acknowledgement or online tracking. And the authorization is received back using FAX. What a joke!<p>My wife didn't hear about the treatment for 3 weeks. Under pressure, she called her insurance. Insurance says, they didn't receive any request for authorization.<p>Why the fuck didn't the medical provider follow up? Exact question asked by my wife. Medical provider's explanation was that they faxed and were just waiting on insurance. They just sat on their fat bums while the time was running out.<p>So, wife patiently asked medical provider to apply for authorization again. The provider said they sent another request right away.<p>Another week later, wife had to call insurance again to find out that they STILL DID NOT receive any request.<p>Distraught wife asked insurance rep to call the medical provider immediately. Of course the call went to voice mail.<p>Wife then called the medical provider and left a scathing voicemail, threatening to sue. Only then this system worked miraculously. It still took a day for the medical provider to figure out what was wrong with their fax system. It still required my wife to follow up with insurance asking if they received the authorization request. Then 3 days later, the insurance provider approved the authorization and my wife had to call the medical provider again to confirm that the authorization was received.<p>All good now? Ohhh Noooo. Now the medical provider placed an order for medication that needs to be shipped from a pharmacy in another state. And they do place it. Now my wife gets a call from the shipping pharmacy to schedule a delivery. The delivery happens after 3 days.<p>Wife checks the delivery. Oops, it is missing a few items required for treatment. Guess what she needs to do to get the missing items delivered? You guessed it. Have the medical provider do the authorization process ALL OVER AGAIN.<p>Oh, and every call to the medical provider goes to a voicemail to which they take a minimum of 8 hours to reply and every call to insurance has a 30 min elevator music. Imagine all this 10 times in 3 weeks and that was just one round of shipping and nervousness.<p>Fuck American Healthcare.
> Some suggested I go to Walmart for $25 insulin, an older type I have no idea how to safely use.<p>I'm sorry but this erodes my sympathy significantly. Learn about the options that exist if your first choice treatment isnt available. Learn about mitigation when <i>no</i> treatment is available. This is <i>your</i> life, act like its your responsibility already.
> The price of my prescription without insurance was $339 per vial of insulin<p>In most countries insulin price is around $30. I remember it was cheap in US too.<p>Seems like another problem created by US kleptocracy. Make something prohibitively expensive, and "solve" problem by providing handouts to cover costs.
We (Americans) are in this situation simply because we have avoided making hard decisions in our healthcare system, and in many cases created actually done things that break the system further (limited to no healthcare rationing in Medicare, mandatory acceptance of pre existing conditions, attaching private insurance to one’s employer rather than the individual, etc.)<p>In short we haven’t come to a consensus as to derivation of the engineering axiom, you can have 1) broader access 2) quantity/quality 3) affordability —-pick two
Dude should have called 911 when he was at 12 hours of insulin left and let the hospital and the insurance company fight it out.<p>That's seriously f'ed up.