The problem with health insurance

United States
August 28, 2012 11:30pm CST
I recently ended up in the hospital for a three day stay. In a way, this angers me because the reason I was in the hospital is because of my health insurance. I take proton pump inhibitors and my doctor agreed after my last hospital stay that I needed a different medicine. He called in three different medicines. Each one of these were turned down for a different reason while the health insurance insisted that I could stay on the medicine I have been taking. I have been in and out of the hospital several times over the last few months with gastritis and internal bleeding of ulcers. Instead of covering the medicine I need, my health insurance company is instead paying for hospital stays which are much more expensive and would not be needed if they would simply cover the medicine I need. The power of insurance companies angers me because someone sits behind a desk who does not know me or my specific needs and decides that they have the power to decide whether or not I should be allowed to get better. They are not doctors but they determine whether or not a medicine is appropriate for us. I was sent a letter in which the insurance company said I needed a different medicine before the rejected medicine was covered so I contacted my doctor for the prescription that was mentioned and he ordered it. I then went to the pharmacy to pick it up after it had been preauthorized only to be told that the insurance company will not cover that medicine. It angers me that these companies can play a game with our health and we are only a pawn in it.
1 person likes this
4 responses
29 Aug 12
I think you are solely responsible for your own health and for the medicines you opt to take but if it was clearly written in their policy, you can't do about it. I don't understand also the reason behind why they should decide which medicine is right for you. And at least they should have done it sooner before your medicine was covered in your bill. Now you have to pay for the disapproved medicine because they told you that they prefer another medicine. That was really something that takes a lot of patience to deal with. Maybe you have to talk to them and explain thoroughly your side. I hope they would cover the cost of medicine as that is the purpose of having an insurance.
• United States
29 Aug 12
I am trying to find a way to either get my medicine approved or come up with the money to pay for the prescription that is sitting at my pharmacy. I already checked into free programs but I will not qualify since I have insurance. There are so many loopholes.
29 Aug 12
definitely you cannot qualify for any free programs in the hospital because you have an insurance. That's the best thing you can do to get your medicine approved by your insurance. Health insurance always have loopholes and some of it may only be recognized if you are hospitalized.
@SomeCowgirl (32191)
• United States
29 Aug 12
To be completely honest I don't have health insurance, and I don't like doctors. That isn't to say that I don't have health problems as I do but I try to treat them as natural as possible. I like to think I know my own body and if I see a sign I don't like, I'll go to the hospital. This hasn't cost me a lot, and I hope it never does. I hate how doctor's and insurance companies have such control over us and our health. You know I read an article once that stated most healthy people HARDLY EVER step foot into a doctor's office, they simply refuse to do so. I am hoping that the health insurance company you are with straightens up, they have no right to dictate what you can and can't take for your own health. THAT is just dangerous in my opinion.
• United States
29 Aug 12
I completely agree. It is wrong how much power the insurance companies have. I am calling my doctor tomorrow about a letter of petition so I can get my needed medicine. If that does not work, I am prepared to write the senators and governors in Ohio until I can get results. People need to be proactive with their health or insurance will walk all over their rights.
@GardenGerty (157552)
• United States
29 Aug 12
That is one of the major drawbacks of the current system. I do not know if one insurance company is any better than another in this case or not. I have no insurance of any kind. I get free pharmacy discount cards in the mail. Would that help enough to get you what you need?
• India
29 Aug 12
Hi friend, sad to hear about this, we must select the best health insurance company to get benefits, now a days lot of insurance companies are available and it is really HARD to find the good ones from them