ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

In Defense of 'Obama-care'

Updated on February 1, 2012

Health Insurance Hurdles

Years ago I visited a woman who'd been admitted to the hospital for a hysterectomy and a related surgical procedure. Days earlier, she'd done all the necessary pre-ops - blood draws, chest x-ray, insurance clearances and admission forms.

At 5:30 a.m. the day of surgery her husband took her to the hospital and she was admitted. About 7:15, gowned and IV'd, she was visited by her surgeon, who told her the operations were cancelled. Why? Because her insurance company had decided not to cover the second procedure after all, even though both surgeries had been pre-approved.

The result? She was discharged, had to wait three weeks until an appeal was finalized and the second procedure was approved again after all, then went through pre-op tests and application procedures once more, had the twin surgeries and was billed for her share of both admissions! That's how insurance companies control the U.S. health care system.

It would be years later when I encountered those same controls myself. In 2005 I needed surgery for a hernia on my left side. Though I told the surgeon in advance (and again the morning of my operation, as well as nurses on duty that day) that I get sick on anesthetics (unable to stop vomiting), everyone assured me that preventive measures would be taken and I would be fine.

Following the operation, I got sick in recovery and remained sick for more than two hours. After that, my wife drove me back to our hotel so I could rest. About five o'clock we went downstairs to a restaurant, since I was weak but hungry. I ordered chicken noodle soup and took one Oxycontin pill (rather than the two prescribed).

Twenty minutes later I was throwing up - and kept on until early the next morning. Calls to the hospital and surgeon's office garnered the advice to 'tough it out' and then go to the ER if I didn't get better by ten a.m. I didn't improve, so off to the ER we went. Three and a half hours later and two IV's of medication, I was well enough to travel the 90 miles back home - where an additional bill of more than $400 eventually arrived.

Two years later, almost to the day, I developed a hernia on the other side. After the surgeon examined me and confirmed that I did need another operation I said to her, "Two years ago I got deathly sick on the anesthetic and ended up in the ER. This time I'm going to be admitted to the hospital for surgery."

She looked at me and said, "No, you aren't." When I asked why not, she said, "Because your insurance company says this is an out-patient procedure and they won't pay for any in-hospital charges." I protested, saying I'd rather see the money for an ER visit spent on a room, even if I had to pay the balance myself, but she said, "No chance." So, I went to the out-patient clinic again and had to repeat the entire horror show of two years before, right down to paying similar charges for another visit to the ER!

Then, last fall (2010) our family doctor prescribed a new low-dose medication for me. The prescription was for one pill a day for 90 days, with three refills. When the pills arrived, however, there were only eighteen of them - with three refills. I phoned the mail-order pharmacy and asked why the number of pills had been reduced and got this answer: it's a medication that requires pre-approval (though we were never told that).

So I asked, "How do I get them approved?" They told me to have my doctor send a letter to an office address they provided, saying that she was requesting prior approval of the drug. I passed on that information to my doctor's office and several weeks later received a call from the doctor's office assistant, who told me the request was denied because I had never tried an even smaller dosage of the same medicine.

I asked what the next step might be and was told we'd have to try the lower dosage first and have the doctor state that this was a "medical necessity." If approved and if that miniscule dosage wasn't enough, then we'd have to tread the 'pre-approval waters' all over again!

Isn't medical insurance coverage wonderful in this land that boasts of the best medical system in the world? And yet we are beset by people who lobby against a 'government-run' health care system. Well, just in case those persons haven't personally experienced a tightly controlled health care system that ignores common sense, let me assure them that we already suffer from one of those.

I say let's try a different approach - maybe enact the plan already approved by Congress, or perhaps a one-payer system after all. A family we know who live in both Germany and Switzerland are doing just fine with their health care!

Comments

    0 of 8192 characters used
    Post Comment

    • chefsref profile image

      Lee Raynor 

      6 years ago from Citra Florida

      I thought the right wing stood for rugged individualism yet they do not want people to be responsible for paying for their own health insurance. Anyone without medical insurance goes to an emergency romm and we support emergency rooms through higher insurance rates and local taxes. So much for the rugged individual.

      I've had experiences similar to yours where insurance found a technicality to deny care. That is the conservative Capitalist way. The best thing we can do to support the current insurance system is to die early without expensive medical care

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)