Insurance Wars

Hav­ing now been released from med­ical lockup for what appears to be very suc­cess­ful cor­rec­tion of a long-standing issue (time will really tell), I feel it is safe to relate the behav­ior of my insur­ance com­pany prior to my admis­sion. I did not feel safe dis­cussing said insur­ance company’s behav­ior before my admis­sion because quite frankly, they held my life in their hands. And to be hon­est, I have seri­ous doubts about their intent for the future for my life. I could blame their behav­ior on big busi­ness, but since I work for big busi­ness, the touch of evil that I sense in their behav­ior just seems to go beyond try­ing to make a buck.

I have to take back that last state­ment. I am not totally sure their behav­ior reflected evil. No it might just have been plain old stu­pid­ity. Whichever it was, it sure was uncar­ing, and in the end, their behav­ior did not save them on sin­gle penny.

I must take War­farin because of my arti­fi­cial heart valve; this cre­ates a com­pli­ca­tion for any sur­gi­cal pro­ce­dure. It is nec­es­sary to stop tak­ing War­farin, then intro­duce a short act­ing sub­sti­tute (often Lovenox) and finally start an IV Heparin bridge. This typ­i­cally extends the hos­pi­tal stay by a few days. If not done prop­erly, the con­se­quences can either be exces­sive bleed­ing or a stroke. Nei­ther are accept­able alter­na­tives (at least I sure do not think they are acceptable.)

The first insan­ity was the refusal of the insur­ance com­pany to fill my pre­scrip­tion for Lovenox. The excuse pro­vided was that I did not need Lovenox because I was tak­ing War­farin. It took four days and an unknown num­ber of phone calls to get a sane per­son to admit that the pur­pose of Lovenox was to be used by per­sons who take War­farin when they have to tem­porar­ily stop tak­ing Warfarin.

The sec­ond sig­nif­i­cant insan­ity was related to the approval of the request for the surgery. The request was first for the surgery and sec­ond for the Heparin Bridge. The request was writ­ten for three days for the surgery and two days for the bridge (one on each side of the surgery). Because I was suf­fer­ing from an infec­tion that could only be cor­rected sur­gi­cally, the sur­geon wanted to pro­ceed as quickly as pos­si­ble. First the insur­ance com­pany decided to delay even review­ing the case. They announced that by their rules they had a week to review the paper­work and they would take that week even though the sur­geon wanted to per­form the pro­ce­dure six days after the paper­work was sub­mit­ted. It took four days of phone calls from the sur­geon and the hos­pi­tal to even get the paper­work reviewed. And guess what the geniuses at the insur­ance com­pany did? They approved the surgery! But, they dis­ap­proved the heparin bridge. There is no sur­geon in this earth I would let touch my body who would oper­ate with­out the bridge short of a life-threatening emer­gency. But then even the insur­ance com­pany admit­ted that once I was admit­ted, if the doc­tors and the hos­pi­tal decided I needed to stay in the hos­pi­tal, they would have to approve me stay­ing in.

In the end it was all a bunch of unnec­es­sary waste and stress. In the end, I got admit­ted and the peo­ple who should be mak­ing the deci­sions about my care were in charge. But before that, the insur­ance com­pany wasted a tremen­dous amount of time of the employ­ees of all of the med­ical offices I dealt with. The insur­ance com­pany also caused Still Here Too and me a tremen­dous amount of unnec­es­sary stress at a time when we did not need it.

As I said, I do not know if they are evil or just plain stu­pid. But the insur­ance com­pany sure was not look­ing out for my best inter­est, the med­ical community’s best inter­est, or really even their own best inter­est. I hate to think the insur­ance com­pany was just being mean for the sake of being mean. But who knows.

Is Still Here