Disclaimer: This post is from the perspective of a subscriber to medical insurance.
Lately, I've been having a lot of thoughts about the way medical insurance companies work or rather, don't work. About two years ago, I found myself sitting in a bariatric surgeon's office discussing options for weight loss due to my various other medical conditions that I struggle with. I was in and out of the hospital a lot two years ago. I have two different back diseases - facet joint hypertrophy and degenerative disc disease. I also have fatty liver disease as well as gastroparesis. In the way of eating healthier and exercising, these two very conventional means of losing weight are unfortunately not very much on my side due to my medical issues. The issues I have with gastroparesis makes it difficult for me to eat healthy as a lot of the things I'd have to eat aggravate my gastroparesis and cause it to flare up. On the exercise front, I'm in a constant state of pain with my back issues so I'm very limited on exercise to the point where it wouldn't be enough to lose the amount of weight that I need to.
The doctor wanted to perform gastric bypass on me for this reason but also because the surgery would allow them to bypass the stomach. My stomach paresis causes my stomach emptying to be delayed by four hours. Unfortunately, even with the more than justified medical reasoning, insurance will not pay for it. In the past three years, I've had two different types of "working insurance" and they both will not cover it even if the doctor has a medical reason for it. If I chose not to work and got Medicaid, I'd be all set as it would be covered. Now, I could end up with diabetes, cirrhosis of the liver and the list goes on. What baffles me the most is that insurance is willing to pay out more in the long run to save on an upfront surgery that could prevent them paying out more in the long run. Now I could understand if the patient in question was healthy enough to lose weight on their own and just wanted gastric bypass surgery for quick results, cosmetic reasons, etc. But insurance companies are not thinking in the long-term that they would have to pay for potentially countless other medical treatment for various other medical conditions that they may could have avoided if they just covered gastric bypass. At least change the terms and conditions of covering it to where it's pending pre-authorization.
I got so discouraged two years ago that I just gave up on any and all idea of ever getting healthy. I felt like the healthcare system failed me, insurance failed me. But this is not the first time I've been through this. This also applies to the mental health field all the way up to my recent experience at the podiatrist. Two years ago, I was able to get two toenails removed at one appointment. The podiatrist informed me at my appointment this past Thursday that now insurance makes them schedule each toenail removal separately. For what reason when you have to get them removed anyways? The insurance company also won't cover preventative measures to have toenail growth corrected. So again, you rather just keep paying for patients to have reoccurring issues then? This is all crazy to me!
I get that insurance companies don't want to pay out for anything that is not necessary or "cosmetic" but at least allow coverage under the terms and conditions that the treatment is necessary per the doctor to prevent unnecessary reoccurring issues. This topic really infuriates me as people have to suffer at the expense of the insurance companies, but more so, if you're a lazy couch potato who just doesn't want to work and gets Medicaid, you're all set - but the working people are screwed, am I right? Do I have that correct? Are we seeing out of the same lense here? This all stems back to even when my mother-in-law fell sick.
Obviously, the hospital took care of her conditions because a hospital can't deny you with or without insurance. However, when it came to her being transferred to the rehab center, insurance only covers 100 days max in a rehab center despite your medical condition. So, what you're telling me is that you're going to classify and group up everyone as a whole instead of looking at all the different variables that determine who may need more or less time in rehab? Why are they not making exceptions based on individual's situations? You can't compare someone who had a broken femur to someone who had a massive stroke. Make that make sense?
Now, I don't know the ins and outs of insurance - I'm only speaking from a subscriber of insurance and what I have personally experienced with it. I'm only seeing it from one perspective, so if anyone who has more incite on what I'm experiencing and can teach me something more about this topic, I'd definitely be open to having a further discussion on this.
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