Wednesday, August 19, 2009

911-Insurance Companies Deny Coverage of Vital Medical Care;
Patients Running Out of Time

Healthcare has reached crisis proportions in this country and the American public is at risk. You may know somebody whose health insurance refuses to pay for needed medical treatment even though that person thought he/she would be covered.

Contrary to what some believe, this is not only happening in systems like Medicare and Medicaid, but shockingly with private insurance plans too! Some of these plans are not inexpensive, and if you think that paying a higher premiom protects you any better then think again! You are being lied to.

I came across this information while I have been persuing my own appeal of a drug called Benicar used off-label to treat my Sarcoidosis. This is a drug usually used (and FDA approved for high blood pressure) but when used along with several longterm antibiotics in a cutting edge protocol it helps eradicate the bacteria that fuel Sarcoidosis and some other autoimmune diseases.

Because the drug isn't specifically FDA approved for Sarcoidosis and at this higher dosage, Medicare Part D refused to cover it and sent me a letter telling me that I could only receive toxic and very dangerous anti-cancer drugs or TNF-Alpha Blockers (also called "Biologic Medicines"; drugs like Remicade or Enbrel). I have researched all this in great detail and I also have read the raw data which reveals that some of the "approved" drugs' clinical trials contained so many adverse reactions (including deaths) that they had to be called off early, and Remicade now carries a black box warning; the most severe warning issued by the FDA. There is quite a bit of evidence that the biologic medications and in some cases also the anti-cancer drugs shorten one's life expectancy even more so than the diseases they are approved to treat. I do not want that for myself, nor should the FDA be OK with that for anyone. Benicar is much safer, and is for many people more effective.

I am on appeal stage 3 after months of stonewalling, denials, delays, and other tactics used by Medicare's default company, United Healthcare (note that even when you don't choose a company Medicare now forces you to go through a private health insurance company for Part D drug coverage).

Interestingly, when my medications were covered by Medicaid for the previous 6 years I had no trouble obtaining the medications my doctor prescribed for my disease. These medications prevented me from dying at a time when I was quickly headed that way.

Now, months and several appeals and phone calls later my disease has taken a turn for the worse. I knew it was only a matter of time and I have been trying to tell Medicare/United Healthcare that they must reverse their position before my health began to decline. They chose not to listen. Over the past several weeks I knew something wasn't right. My pain level has become worse and more frequent, the fatigue has increased, I began to lose my apetite slowly and to lose weight again, and then I began having more and more trouble getting air into my lungs. At first this was just every once in awhile and I thought it might pass, but as time went on the episodes lasted longer and happened more often.

I began waking up at night choking and gasping, and for the past two or three weeks have had to sleep with my head propped on several pillows in order to sleep long enough without interruption. Even that is becoming less reliable.

Recently I have been feeling an odd sensation in my lungs as if I have breathed in powder that I can't clear. Sometimes I cough and sometimes congestion comes up and at other times it's just a dry cough.

During the past 2 weeks I get sharp pain in my lungs on the sides, front, and back that is sometimes piercing, and sometimes I have a dull general ache in the whole lung from top to bottom. This is worse with even a small amount of exertion now such as walking to my mailbox, and taking a trip to the post office is agonizing.

My stage 3 appeal papers are supposed to be coming in the mail from California where the most recent arm of Medicare (Maximus) is located, and once I fill those out and send those back I should receive a decision at that level. If the answer is again "no" then I will have to take the matter before an Administrative Law Judge. A representative from United Healthcare (one of the nicer ones) told me on the phone the other day that she would not hold out much hope that this appeal (either stage) would be successful. Be that as it may I can't just lie down and die when maybe it can be prevented if caught in enough time. What other option do I have but to appeal it as far as I can?

I've written Barack Obama, the Center for Medicare/Medicaid Services (CMS), called and written numerous advocacy agencies and attornies, and also tried to have my doctor help, but he is getting frustrated and is getting to the point that he doesn't want to bother anymore appealing it on my behalf.

One night I decided to look and see what other people were experiencing and to look into just how commonly people are not getting what they need medically due to insurance rationing practices of various kinds.

YouTube is a goldmine for real stories about real people and I located quite a number of cases in which people were being denied all kinds of medical care because of the greed and lack of compassion of an insurance company.

Not only did I find video journals documenting first-hand accounts by patients, but I also found some video confessions of those who used to work for entities guilty of such inhumane practices. These are only a few of the many that are out there and the numbers continue to grow.

Insurance Insiders Speak The Truth:
Death By HMO C Edwards http://www.youtube.com/watch?v=C3so7EdKpCY


Linda Pino Confession http://www.youtube.com/watch?v=DKVLV9bR1bo&feature=related


Linda Pino on Heathcare http://www.youtube.com/watch?v=rz7n8JtAhJo&feature=related


Linda Peeno, MD- SiCKO: What Has Happened to Health Care?"
http://www.youtube.com/watch?v=TqSshZZMHGA&feature=related

This one is particularly insightful about how the job made her desensitized over time and illustrates the ways in which doctors start to rationalize delivering sub-standard testing, diagnosis, and treatment:
Project Sin Alma: Linda Peeno on Denial of Care http://www.youtube.com/watch?v=N-5S2rZ_eYc
Inside the Insurance Industry http://www.youtube.com/watch?v=5101qEtPDSA&NR=1

People Denied Care:
Dropped Coverage (Breast Cancer) http://www.youtube.com/watch?v=hd5ApRsvRUM

Terminal Health Insurance (Breast Cancer) http://www.youtube.com/watch?v=7gYTZakdG4k


Faces of Health Care Reform: Lisa (Hydrcephalis) http://www.youtube.com/watch?v=0oxScKmfr38&NR=1


Why must we suffer to survive--doubting lyme
http://www.youtube.com/watch?v=_F_6W9IFO0E&feature=related


Isabella fight against UnitedHealthCare
http://www.youtube.com/watch?v=EmAfYq3uDu8&NR=1&feature=fvwp


United Healthcare Oxford Medicare Advantage Denies Coverage http://www.youtube.com/watch?v=H8erunWFyT4


Medicare Patients Being Turned Away
http://www.youtube.com/watch?v=pGTqqQkMIDU&feature=related


CUNA credit disability insurance - $6 MM penalty for bad faith claim denials http://www.youtube.com/watch?v=dUzAlGPweB8

In closing I just want to say that this is exactly why the Public Option is so needed and why the private insurance companies need regulation to keep them from allowing patients to die. I am going to say something that to some may sound extreme, but I think it's appropriate under the circumstances we are faced with. The current system of healthcare is socially accepted genocide. Human beings are supposed to be more evolved than to allow Social Darwinism to rule what should be compassionate decision-making and we have the higher brain ability to rise above the baser instincts and to make the conscious decision to take care of our own because it's the right thing to do.

If you are a patient who is sick, or you know somebody who is, please flood the White House with letters and ask him to stand strong on his promise. The current way is not working, neither in private healthcare nor in Medicare and Medicaid, and a "healthcare Co-op" will not assure a level playing field for the sickest or the poorest Americans. The address is as follows;

President Barack Obama
The White House

1600 Pennsylvania Avenue NW
Washington, DC 20500

You can also call: 1-202-456-1111
or fax your comments: 1-202-456-2461

To you doctors out there reading this; please stay strong in fighting the real enemy; the flawed healthcare system, not the patient. Having to jump through these hoops while we are ill is more than we can do alone. Your advocacy is needed in the battle which lies ahead. Human lives depend on your not giving into the pressure to ration or disconnect placed on you by the profit machine. Remember that each of us one day will encounter something sooner or later from which we may not bounce back, and that the system we start to create today is the same one we will have to live in tomorrow. Be a part of the solution. Refuse to become part of the problem. Medical decisions should be based on need rather than on cost. Patients and doctors must insist on this and refuse to compromise that principle.

5 comments:

Giftbearer said...

The best of luck to you from Australia. Hope the medication is approved and that you health improves...

Giftbearer said...

Thanks for you comment and well wishes! Hopefully also more and more people will challenge these inhumane healthcare practices and the whole infrastructure will improve so that this doesn't keep happening to people.

Giftbearer said...

Thanks for your comments and well wishes! Hopefully the infrastructure will change once enough people make their voices heard to the President and to other legislators.

Giftbearer said...

let me know if there is anything i can do to help. i want the best for you!

Love,
Mal Mal

Jan 4 Insight said...

Thank you for coming over to my blog and commenting on my health care post. Your experience is very troubling, and I wish you the best and sincerely hope you will get the care you need. We all need to keep fighting on this, and doing everything we can do to get a strong health care reform. The insurance co's have too much power - in fact, they are the ones who pushed through the Medicare part D that is being such a roadblock to you.