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.