Eric Stoner is writer for The Huffington Post. He also suffers from cystic fibrosis (CF), a genetic disease that attacks the digestive and respiratory systems. Despite major advances in medicine, most CF sufferers do not live far past 40, often dying from everyday infections that become life-threatening.
There are roughly 30,000 documented cases of CF in the United States. Since it is a relatively uncommon ailment, the market for treatments and medication is quite small. Stoner quotes his annual prescription costs at $60,000 per year! As he points out, this makes him a dream customer for the pharmaceutical companies and a nightmare client for the insurance companies:
I'm the worst kind of member to have on the rolls: someone with a chronic illness whose medical expenses, as long as a cure remains elusive, will always be exorbitant. I show no profit potential.Stoner then goes on to share his disturbing and demoralizing adventures navigating the byzantine bureaucracy of insurance and health care. His experience resonates with many who have been subject to the "non system" of American health care.
Not surprisingly, then, navigating the health care system has never been easy for me. Even when the system is working as smoothly as it can, I have had to jump through countless hoops. Those are an unavoidable and exhausting part of this tortuous circus. But my experience in insurance company hell reached a new low last year. Last November, I spent weeks politely jostling my inept doctor's office and insurance provider to get one of my prescriptions filled. Nobody seemed to take me seriously or put any priority on my case, even as I stressed that I was quickly running out of my medicine. To my disbelief, I began to realize that I did not have intrinsic value in their eyes, but had effectively been reduced to a "member number" and data on their seemingly endless medical forms. And when your needs become too expensive -- since the price of life apparently can now be calculated -- the companies find every possible way to dodge their obligation, playing the role of absentee landlord or deadbeat dad to perfection.
He recounts the extensive phone calls with his provider, including a four-day stretch where he was on the line literally all day each day. As each obstacle was overcome, it was replaced with another, a seemingly endless stream of complications, requirements, and red tape. On several occasions, he was told to go to the emergency room.
After reaching the point of desperation, Stoner got in touch with a lawyer friend who agreed to apply pressure on his behalf. Oddly enough, the very next day he was contacted by the suddenly helpful provider with full approval for his treatment.
There was no explanation. The extensive documentation that they had been demanding was, in the end, unnecessary, as I suspected. I rushed to the pharmacy. But by the time I was able to fill the prescription, I had already gone three days without it.The unfortunate part is that this only covers the beginning of his outlandish odyssey. A mere few weeks later, the same provider once again refused to authorize medication prescribed by Stoner's doctor. Only the threat of legal action was able to cut through the red tape involved.
My fragile health was put at risk because some faceless suit wanted to save a buck and was testing to see how much of a fight I would put up. (I was told more than once by people who had their own horror stories with health insurance that companies hope you'll just give up. Whether it's true or not, that is definitely how it feels.) It was an emotionally exhausting process that I hoped I would never have to endure again.
Not only is this an important view of the incredibly convoluted processes involved in attempting to get health care, but Stoner's blog entry also has a very interesting set of reader comments that further amplify discussion of the issue. Go give it a read and let us know your thoughts.
SOURCE: "Criminal Health Care" 03/10/08
Artwork: "Red Tape Machine" by Dustin McGahan, courtesy of grifray, used under this Creative Commons license