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Who’s in charge here, anyway? January 3, 2014

Posted by Judy in Musings.
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4 comments

Healthcare in our country is a train wreck. Some people have great coverage. Some people have terrible coverage. Other people think they have great coverage only to find that they, in fact, don’t. Many people think that their doctors are making health decisions for them when in reality, it is the insurance companies. Case in point. Several years I got physical therapy for my back. I had to fill out these questionnaires which then got sent to the insurance company so that they could decide how many sessions I could have. Long story short, they didn’t approve very many, even though the therapist argued with them that my issue would take some time before seeing any improvement. They didn’t care. I didn’t get the sessions I needed and the problem went unsolved. Thanks alot, health insurance!

And then there’s the issue of pre-approval. Even though your insurance technically will cover a particular treatment or exam, you still have to have pre-approval from the company before you get the exam. (Well, you could go ahead and do the exam, but then you would end up having to foot the very huge bill.) You may recall that I was supposed to get a PET Scan to determine the cause of the elevated liver enzyme (alkaline phosphatase). My insurance declined the request stating that 1) my cancer didn’t appear to be advanced enough to warrant the test and 2) I didn’t have a CT Scan showing an abnormality with inconclusive results. Instead, they approved a bone scan and a CT scan. A quick google check revealed that a PET scan can be $8000, a CT scan $5000 and a bone scan $1000. It would seem that the insurance company is making decisions on my healthcare from a financial perspective. It’s cheaper for them to approve the other two tests than to approve a PET scan. Who knows, maybe a CT scan is just as accurate as a PET scan. In any case, when the denial came through, my medical oncologist said, “Okay, let’s do the CT and bone scans, then.”

So I ask, who’s in charge here, anyway? SMH