over the insurance barrel

i hate the american health insurance system. it is broken in the worst possible way:

  • everyone agrees it’s broken
  • it’s really hard and expensive to fix
  • any solution would require compromise
  • no one is willing to compromise
  • everyone accepts it as just the way things are
  • most people suffer as a result

it is not a problem of third-world magnitude; i would never compare it with the brutality and suffering visited upon so many in the world. but for a country of 250+ million, there are plenty of people who suffer with this system, and they are mostly poor and underprivileged. i’m not going to whinge about my issues – i just think they reflect a much larger problem, and it makes me furious.

i sprained my ankle amonth ago. it’s not healing properly, and i have a history of injuries to this ankle. x-rays showed nothing. i went to see a podiatrist, a doctor of sports medicine, and he wanted to do a Magnetic Resonance Imaging (MRI) scan to see what the heck is going on. my insurance company has to approve such a test, since it’s expensive (about $2000, which i can’t afford to pay myself). with no other evidence than my doctor’s request, their response (after repeated calls from my doctor with no response) was quite simple:

Review of the available clinical information (Man with trauma to left ankle one month ago. Has continued pain and limited range of motion. X-ray normal. No treatment other than ice and elevation.) does not indicate the need for the requested imaging study.

as a helpful afterthought, they provide the following:

The preceding determination was made in accordance with current NIA clinical guidelines for imaging. A copy of the general criteria used for the determination of medical necessity in this case is available free of charge. Please submit or fax your request to the address of fax number listed. A copy of the clinical criteria will be mailed within 30 days of your request.

well, at least it’s free….and i’ll probably still be in pain in 30 days, so waiting is cool by me.

now i have the option of paying $2000 for the test, or sucking it up and waiting a few months to see if it heals (with physical therapy that i’ll probably have to pay for). at least it’s not like the situation my father faced, where he had to pony up $26,000 to save his own life from skin cancer (insurance company response in that case was "sorry, pre-existing condition").

is there anything to do in this situation but shake your fist at the sky? it seems like that might actually be more effective. either that, or screaming into the nearest hurricane. do people with life-threatening problems get any more compassion? if i were really, really sick, i hope that the system would be slightly more inclined to help, although if my father’s case is any example, i’d probably have more luck trying to jump to the moon.

PS: i realize the insurance companies are businesses that need to make money. it’s not just them. it’s the whole system (the cost of tests, the cost of care, the cost of practitioner liability insurance). it’s all broken. it’s one big Gordian knot of brokenness.

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One thought on “over the insurance barrel

  1. robert

    Sorry to hear about your ankle, I remember you’ve had these problems for years. Standard medicine doesn’t do too much for most of these cases, neither does “alternative” medicine. I’ve got a tweaked shoulder currently, I’m investigating getting cortisone shots to aid the healing. Or testosterone or human growth hormone or pureed baby hearts. whatever. Getting older has it’s downsides, doesn’t it.
    p.s. I’ve started my own blog.

    Reply

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