Tuesday, August 05, 2008

More on "Pro-Life"

One of the things I find fascinating is the shortsightedness of big business, in this case, specifically, insurance companies. They deny healthcare to individuals, deciding a certain treatment is unnecessary, or changing a specific med a doc might have prescribed.

Example of "unnecessary:" My dad has been bedridden since late April (second day of Passover, to be exact). He was in three different hospitals over a period of nine weeks, complaining of horrible stomach cramps (as well as no longer being able to put any weight on his legs any longer). Three or four surgeons have concurred, after weeks of testing, that he needs some kind of abdominal exploratory surgery to search for blockage. The insurance company denied this, saying the surgery was unnecessary.

I'm sorry, what? Yes, they said it was unnecessary. He was discharged from the hospital, still quite ill, and sent home. He is still in bed, can't even get up to go to the bathroom (a mess my mom needs to clean constantly - disgusting!), and has been on phone call after phone call with the doctors and insurance company, until he finally got the insurance company to OK the surgery, at least in theory. But my question is, who the hell are the insurance people to make medical decisions?! Further, this opens them up to major legal action (including, possibly, wrongful death if the patient can't get the insurance company to approve a procedure), as well as causing even more health problems for the patients, costing them, in the long run, much more money than a simple procedure would earlier in the process.

Example of shortsightedness: This is my own experience. As anyone who knows me, or anyone who reads my blog on a regular basis (or both) knows, I'm a fat guy. I weigh, at this point, double my "ideal" weight. It sucks. I've tried diet after diet over the last five years, and while I did lose some weight (even up to 94 pounds at one point), every diet has been a failure, as I ALWAYS gained the weight back. Recently, in the last two or three years, every time I've tried, I'd lose up to twenty pounds, and then it would just stop, no matter how hard I worked out or how right I ate (both at the same time, mind you...). Two doctors have recently told me I'm a really good candidate for bariatric surgery, a weight loss surgery that has helped thousands in recent years. One doctor even wrote a letter on my behalf stating that, based on family medical history (my father's HUGE), bariatric surgery is actually a medical necessity for me, not elective surgery. It's a surgery that costs between $17,000 and $30,000, depending on where you go and what kind of bariatric surgery you have done. Yet, the insurance company simply won't cover more than $10,000 of the surgery, essentially insuring themselves that I will never have the surgery as I simply can't afford it. On top of that, they keep claiming it's my wife's company, through which we have the insurance, that chose the policy that only covers $10,000. Except they don't seem to HAVE policies that cover more, and even if they did, they wouldn't insure me because I have a "pre-existing condition," once again insuring themselves against insuring anyone who actually NEEDS the insurance.

Further, while the insurance company gets to have its way of NOT providing me with individual insurance, they also insure themselves against having to help me lose weight in any MEDICAL, NON-invasive (non-surgical) way, claiming it's NOT a medical condition. In other words, they get to have it BOTH ways, and I get to be screwed, and not in ANY enjoyable fashion, mind you.

The shortsightedness? I've basically given up on dieting. It's simply not working for me. It also means I'm eventually going to get sick, quite likely develop diabetes and all sorts of other crap, and THEN the insurance company will be spending tens, if not hundreds, of thousands of dollars more for me to get treatment instead of just bucking up and paying for the surgery NOW and avoiding all the expenses later.

I'm quite sure how this makes ANY sense, but there you have it. It sucks.

And yet, there are STILL people out there who think the system is JUST FINE the way it is. Ok. Whatever you say. I just pray those of you out there who think so don't develop the problems my dad has, the same ones I'm heading toward thanks to the insurance companies telling me to, essentially, F**K OFF.

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