14 October 2008


Originally, this blog was going to be exploring the topic of needles, and how they have become my new bff. That blog will be written, but first I feel that there is a topic that needs to be addressed a little more urgently...

I will admit fully and freely that I have not seen Michael Moore's documentary, "Sicko," yet. However, I do know what it is about and while I have the utmost sympathy for people who have been royally screwed by our completely fucked up health care system, I had not yet actually had the pleasure of being bent over and sent home after without a kiss or goodbye... until recently that is.

Obviously, this whole collection of blog postings is my journey with a chronic disease, so of course the health care industry is going to be included in the mix. However, right now, I am so frustrated with our jacked-up health care, I just want to go outside and scream.

My friend, Larry wrote a blog for the Huffington Post a while back which states "that just under half of all people filing for bankruptcy met the definition of "major medical bankruptcy."" Now I am not by any means saying that I am on the verge of bankruptcy, but I am definitely reaching a point where I am starting to wonder how this is all going to be covered- and I am considered to have excellent medical insurance.

Today I received a statement from Anthem-Blue Cross for the CT scan I had to have on my pelvis and spine. I was told at the time- by both my rheumatologist's office AND North Valley MRI/CT- that I was not required to obtain prior approval from my insurance company for the procedure. I am sure you could imagine my surprise when I opened the statement to see that I owed all $635.00 of the scan- because I did not get prior approval.

This bill was almost the tipping point, but really that time came about two hours later- something I will get to in a minute, but first I will finish up about my relatively expensive CT scan.

Anyway, this latest medical bill came on the heels of me finding out that I am not allowed to give myself the injections of methotrexate each week, but rather, I am expected to go to the doctor's office and have them do it for me. Oh, but don't worry, it's only about $10 a week... not including the actual price of the prescription. Okay, so bear with me, let's do the math: $10 a week for the office visit (not including the $30 check-ups every three weeks). Minimum $30 a month for the methotrexate and folic acid (need that so my hair doesn't fall out from the methotrexate). Nine blood tests at $7 each to make sure my liver isn't failing and I have enough white blood cells to stay alive. So if my math is correct, that would be $520 for the office visits, $510 for the check-ups, $360 for the prescriptions and $63 for the blood tests. All told, that equals $1,453.00 a year- and that is not taking into consideration the other THREE MEDICATIONS I TAKE DAILY AND FOUR DOCTORS I HAVE TO VISIT ON AT LEAST A BI-ANNUAL BASIS.

Speaking of the methotrexate, the tipping point I mentioned previously, came when I got an e-mail- not a phone call or voicemail- from Walgreen's making a vague statement that there was a problem with my prescription and it had not been filled, even though I turned in the prescription three days before I needed it. I called and found out they don't carry methotrexate injections in stock, so they had to special order it- it should be in sometime tomorrow between ten and two.

"That's really great," I told the woman on the phone, "but I am supposed to get my injection tomorrow at nine."

I could almost see her rolling her eyes and shrugging.

"Well, sorry, but it usually doesn't come anytime before noon, so give us a call around then, and see where it is."

Son of a...

So now I have to HOPE they get it by two, then I get to rush back from Redding, pick it up and run over to Afrasiabi's office by five so they can inject me- for the low, low price of $10. $10 for three minutes... what a deal.

The most discouraging thing about this is that I actually do have medical benefits- really, really good medical benefits, that I pay a fair amount for. This is so frustrating for two reasons: one, I pay through the nose every month for medical insurance, just to have claims denied, and; two, I feel my aspirations becoming pipe dreams.

It is only because of my job and health benefits that I am even able get the medical attention I need right now. I have had several different health plans at other jobs, and I must admit that Anthem-Blue Cross is one of the best so far- but that sort of pigeon holes me. I had set the plans in motion to attend University of Oregon in the fall of 2009, but that is now all but out of grasp. If I were to leave my job for school, I would have to not only figure out how to pay the $17,000 for tuition, but then find the money for room, board, and of course, those pesky medical bills- without insurance. While U of O might be out of reach, I know I can somehow still swing it if I attend Chico State. I will not let this disease destroy my academic career like it is trying to destroy my spine.

I am just so discouraged right now. My legs are in a vice, I can't hold a pencil for more than five minutes, and the stack of bills is getting higher and higher. Today was a bad day.

Tomorrow will be better.


Health care reformer said...

Very interesting and informative. Done so in a matter in which the layman can relate. It further goes to show the deplorable condition of our health care system and the out of control prices put on health.

Jenny Carey said...

Mike's sister Jenny here-- I can totally relate, and what you implied in your post but didn't articulate for those who are not familiar with chronic diseases is that it looks like the charges you calculated are out of pocket expenses. That is what you're paying on your own, after insurance picks up the rest. That is really horrifying, I don't know anyone that has that much money just lying around on hand for a catastrophic, chronic health condition. Good news is that you can claim these medical expenses on your tax return-- make sure to keep meticulous records of any expenses related to your medical care. Bad news is that AS is expensive and our current health care system is not in any kind of shape to actually help you and others like you battling chronic diseases. And what happens if you change jobs, go back to school, or your coverage lapses? You become nearly un-insurable as you will be treated like you've got the plague rather than a "pre-existing condition." It is alot to absorb, especially when you are experiencing side effects and feeling achy, emotional and vulnerable. Once you are feeling better, I would encourage you to call your insurance company and ask to be connected with a case manager. Many insurance companies offer them, they are basically your personal liaison with the insurance company and will help you get the right information the first (or second) time rather than the fifth. You might also call your employer/school's benefits office and ask if they offer any kind of support for patients enrolled under their sponsored plans. Good luck getting that CT charge squared away, and don't be shy to raise some hell. When it comes to insurance companies, nice girls finish last. GOOD LUCK, and hang in there!