Why the HELL Does Health Insurance Exist?

I mean, really?!? Why are people in this country forced to pay out the butt for insurance that is supposed to cover medical costs, yet they don't want to pay for anything? I honestly don't understand anymore.

I used to be a staunch supporter of the health insurance and medical system in this country before I got sick. I guess I was jaded never getting to see how the "other side" sees it. It was easy for me to say, "socialized medicine would kill this country," or insurance companies and pharmaceutical companies are businesses out for a profit, too. And that is true...they are, and I defend their rights to make a profit, but at what point does it become a problem if they are making a profit at the detriment of the general public?

Sorry for the political commentary there. It's just that ever since I became ill, I have watched my insurance company go from a good, helpful company to a dreadful, irritating, almost criminal entity. Something tells me that it's not a coincidence that this has happened since I got sick either.....

The event that triggered my rant here started last month when my health insurance provider raised my premiums by $133 - the biggest jump by far that my insurance has taken over a one-year span. OK...fine, I'll pay more or raise my deductible (as if I can afford to do EITHER of those things).

Well, I go to the Neurologist, as I wrote in my last entry, and they decided to try me on Provigil, a medication to combat fatigue. I take it to be filled at the pharmacy, and they call me a bit later to tell me that they can't get approval from Anthem until my doctor's office provides them with more information.

Fine. I have the NP call the insurance company. Here is what she e-mailed me back after talking to them:

I called Anthem Rx division and gave them additional info to support the use of provigil in your case. They have a physician who will review it and make a decision in the next 3-5 business days ( by next Thurs) They will fax me the decision and notify you as well. Beth

WHAT!?! Are you freakin' kidding me??? So let me get this straight. I went to my doctor who sent me to a specialist. That specialist decided that I needed medication to help with this fatigue that PLAGUES me daily. The insurance company decides that another doctor, an in-house INSURANCE one at that, needs to decide if I NEED this medication??? I'm sorry...have they MET me?? Do they know ANYTHING about me except for what my NP said and what is in my file. Oh wait, they DO know me - remember? I'm the one who made them spend money on 3 MRI's over the last 2 years. That's right - forget it lady!

So you may have guessed by now that they declined to cover this medicine, which by the way is $400 a month without insurance (so what, they would have had to pay $50 with this "reduced insurance rates??"). There are no generics for it. There's no hope.

The NP DID contact me today to say that there is one other drug they can try me on, Amantadine, which is different than the other drug, but it *might* help. Hmpf! Whatever! It's unlikely that the insurance company will cover it either...

What makes me angry is that I only take one other medication - Neurontin. It costs them close to nothing. I do not drug shop. I do not beg my Neurologist or any other doctor for drugs of any kind. I do not feel like I NEED any other drugs, only I was told that this could potentially make me function like a human being every day again...at during tax time - what an added bonus that would be!! I ask for nothing, and when I DO have to ask for something, I still get nothing.

I don't get it. I've been shaking my head in disbelief so much over the last few days that I'm frankly getting pretty dizzy. Something's gotta give...my heart truly goes out to those people, especially the elderly, who need medications and cannot afford them.

No Answers........Yet.

I'm as tired of typing this as you are tired of hearing it, I'm sure:

NO ANSWERS!

Went to the Neurologist today only to get stuck with the Nurse Practitioner - AGAIN! I'm highly pissed!!! I like her very well, and as a matter of fact, I wish she was a Neurologist and not a NP because I would change over to her permanently. Fact is...she's NOT a Neurologist, and I'm paying heavy fees to see someone who does not have expertise in the human brain.

Anyway, she told me that there is still no evidence that they can apply towards a diagnosis. My MRI's looked OK...she did not have the results of my VEP for some odd reason, however. Blah, blah, blah...same old crap. She still believes that I possibly have MS, but at this point all they can do is continue to watch me, treat my symptoms and take action if/when anything else happens.

It's a damn shame that one has to wait until something happens before they can get help. I mean, I understand the whole premise behind that, but it's just crazy. Do I WANT MS? Absolutely not. Have I been told numerous times that it is probably MS? Absolutely! Do I deserve help and answers based on that? 100% absolutely no doubt!!!

On a good note...well, kind of...I finally got my Rx for Provigil. For those who don't know, Provigil is a drug that combats fatigue. Fatigue is one of my biggest complaints, and if I get rid of that, it'll take about 1/2 of my problem away. Problem with this is that I asked for this Provigil at my last appointment with them back a month or two ago, and I was told that Dr. Fee said that he only prescribes that for those who have already been diagnosed with MS. Well, I didn't even mention it this time at all, and Beth (the NP) says, "If fatigue is still a big issue for you, Dr. Fee says that we can go ahead and prescribe you some Provigil." What...the...bloody...hell! Could they not have said that the last time when I asked for it and, at that point, desperately needed it????? Grrrrr......

So the saga continues. And unfortunately, you all get more of my "bellyaching" for awhile longer. I just don't even know what more to say. I mean, I didn't expect to get answers today, but this is just one step forward, two steps back.

On another note, my grandmother (Dad's Mom) was hospitalized over the weekend. They told us on Friday night that she had a "massive heart attack" that stopped half-way through. The doctors painted a very grim picture for us...told us that they would put stints in her heart but that they may not work...told us that she was not a candidate for open heart surgery because of her Emphysema, that she would never make it off the operating table. Our whole family gathered together, and everyone was devastated - crying, praying, etc. They performed the Heart Catheterization on Sunday morning, and surprise, no heart attack due to blocked arteries! She ended up having what they call "Broken Heart Syndrome" where an attack on the heart happens because a major stressful event triggers it. There's been a lot going on with our family, so we can see how that happened. I'm SO thankful that she is OK - she was released from the hospital yesterday, but my goodness, what a stressful weekend it was!!!

Thank you all so much for reading. It's nice to know that there are people out there who care.

I've Been Relaxing........(or trying to)

I'm FINISHED with testing...for now. It's done and over with. Funny thing is that I don't think I remember how to relax anymore. I sit on the couch after the girls go to bed, and I get up and walk around. Then I sit back down. Then I flip through the channels. Then I get up again and go look in the fridge (and don't get anything out, of course). My point is - I CAN'T SIT STILL!!!! I'm so used to having my nose stuck in a book or on the computer, and I just can't sit still and relax. Hopefully I'll learn again soon. It drives me nuts (and Phil, too, who likes to remind me of things like how many times I've gotten up or looked in the fridge, etc.).

So the last test section went very well - much better than expected, at least. I felt like I breezed through it fairly well. Did I pass...well, I'm not holding my breath on that one, but I'm sure I, at least, scored over a 70. (Probably a 74, no doubt. Grrrr... (See previous post))

No news yet on my brain tests either. I think I go back on March 14th, but dates don't stay in my mind anymore. My appointment could have been yesterday for all I know. In the meantime, the fatigue is still around, as is the burning and sharp pains. Blah, blah, blah...story of my life.

The girls are both very well. Maddie is still enjoying school and is doing very well with writing and recognizing her letters. She LOVES to go to church and cries the whole time I'm gone when I don't take her. She's got so many little friends now that it's hard for me to keep up with the parents as far as whose turn it is to have the kids over to play. Guess that's not such a bad problem to have...except that when you can't even remember your own name, the kids get pretty upset when you call them by some other kid's name. Whooda thunk that??

Mackenzie is *SO* funny. Well, she's as aggravating as she is funny, but that's another story. She's talking so much better - it's like her vocabulary just exploded one day (some words not as good as others - for example, her latest "fun" word to use is "poopyhead." Where she got this, I don't know. I'm not happy.). I was getting ready for a meeting this morning, and I was pretty dressed up. She came into the bathroom, tugged on my shirt, and said, "Mommy. You booootiful!" *sigh* Be still my beating heart. (Yeh, yeh, and I'm eating it up, too...heck, if I can get even my 2 year old to tell me that after all of the weight I've gained back, I'm doing OK - LOL!)

That's enough for now. My hands hurt...and so does my brain.