Hoping For Affordable Health Care For All!
Posted: Monday, August 03, 2009
by Iris Taub
I received an interesting challenge from the assignment desk asking me, and I am sure others, if our health insurance is working for us!
Tough question to answer when there seems to be more and more people loosing their jobs and the issue of pre-existing conditions.
Before I won my battle with disability and was forced to stop working due to complications of my fibromyalgia, I was faced with the reality that not only did I not have a job, but lost my insurance as well.
I was forced to hold my breath for almost four years until I was finally insured again.
First I had the battle with disability after being gainfully employed for almost 35 years and then I had to hire a law firm to represent me. It was a humiliating experience being forced to see doctor's that were trying to prove that I was capable of doing some sort of gainful employment when my own private physicians had documented proof that my fibromyalgia was compromised because I was intolerant to any of the traditional forms of medication that was prescribed to control the symptoms associated with this condition. This ordeal went on for over a year and finally I was told my case was going to trial. Luckily, the judge reviewed my medical records and made an out of court decision that I was indeed disabled and I was awarded disability.
Made it through hurdle number one, however, you still are not eligible for Medicare disability for another two years. I was a total wreak and every time my doctor's wanted to try and prescribe something new to try, I hesitated since I was afraid that if I had an allergic reaction, I would wind up in an emergency room and I had no insurance. After a long two years, I finally became eligible for Medicare and I chose to use a PPO program which would handle the deductible for the beginning of the year, and also had low co-pays. Luckily most of my doctor's accepted the plan so I was more than happy to use it.
Unfortunately, with most PPO's and HMO's the prescription portion of the plans will only cover certain drugs, and recommend generic when available. It might work for some, but in my case, it doesn't cover medication that I am presently taking.
When you are on a fixed income, you rely on your insurance to cover medication that is required to manage your condition. Up until recently, there were not many options out there to try.
My Rheumatologist wanted me to try a drug called Savella which is an approved fibromyalgia drug that has been successfully used in England for at least 15 years. Although the drug has recently been approved by the FDA in this country for the treatment of Fibromyalgia, my insurance company does not cover it and I was informed that even if my doctor wrote a note requesting it, there was no guarantee that they would even consider a co-pay that was reasonable. I was told anywhere between $90 to $180 every three months and that price could change without notice.
It is very frustrating when you are sensitive to traditional forms of treatment and you think there is a light at the end of the tunnel from your chronic pain 24\7. I luckily contacted a company called FreeMedicine.Com. Their number is 1-573-996-333. They were wonderful and for a processing fee of $10.00, they filled out an application for me on my behalf to get the Savella for either free or a very low cost. I received the package today and have a card to bring to my physician and to the pharmacy. Not sure how this actually works since I haven't tried it yet, but I wanted to share with other's that number so that they could get more information on how to get assistance for medication.
We are all facing a crisis involving health care and in which direction it is going. For those who are already insured, they fear that their premiums will get so expensive that they will be forced to drop it and there is no guarantee that they can get insurance with another company either.
If you loose your job, and there is no cobra plan and you have a pre-existing condition, where do you turn?. I know first hand what a nightmare it is to be without insurance and the fear of being ill.
More and more Americans are facing this problem every day and to them, any kind of plan is better than no plan at all.
We listen to the pros and cons of what the president wants to do for those of us who fall in that category and it is easy to say that you don't care if you have insurance but if you lose your job or the premiums are out of reach, it will concern you!
In my opinion if they can finally figure out a way to get something going, either a sliding scale depending on income, an plan for those 55 and over to buy into Medicare at a discount price or even a state plan, I think it would create a healthy competitive edge with the existing insurance companies and give all Americans the choice to have some sort of insurance.
What do you think!
Iris S Taub
Parkland, Florida
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Top-level comments on this article: (6 total)Suzy,Thanks for taking the time to read my article and respond to it. I have some additional information about the drug assistance company I was disappointed when I called them yesterday to verify just how to take care of that prescription. I called three separate times and got three separate answers.One person told me that there was a $30.00 savings, another told me there was up to 75% savings and finally the third person told me that Savella wasn't a drug covered by their program. I was disappointed and upset so when I spoke to that third person, I told them that I was upset that I had to pay a $10.00 processing fee and that I wasn't going to be able to get the medication. She then told me she would add the Armour Thyroid instead for savings. Haven't tried getting that medication either by the pharmacy but I will keep you and others informed when it is time to renew it.Also as far as not having enough physicians to go around, I am not sure what your state has but more and more heath centers are opening up so I think there is going to be a lot of centers available for those who have emergencies. Yes, it is true, that it might be hard in the beginning but I think that eventually, things will work out for all concerned.Iris S. TaubParkland, Florida
Hi Suzy,Thanks for the information about Dr. Mercola and the info on covertheuninsured.I am truly sorry about your friend but depending on how long a time passed, would determine whether or not the lung cancer would have been detected. Like you said, what if's don't solve the problem.I do have insurance called Medicare Complete which does cover doctor's visits but the prescription portion has a lot to be desired. Luckily I don't or I should say, didn't take a lot of medications so it really didn't concern me.I have also been in the health field for over 35 years and like the natural or holisitic approach to things as well and have a diet rich with Omega-3, I take lots of vitamins and supplements and taking a special form of Calcium with Vitamin D prescribed by my Rheumatologist. I also make it a point to drag myself to the JCC every other day to use the elliptical on the strength setting for 15 minutes, then use the weight equipment for a half hour and finish off my routine with 15 minutes on the treadmill. Aquatics are also a great way to keep fit but unfortunately, the JCC has an outdoor pool and the hours that it is available are too late in the afternoon for me to take advantage of it since I am too tired passed 1:00PM to exercise. I also make it a point to stay away from preservatives and to drink plenty of fluids and make sure I have enough protein in my diet to hopefully build muscle tone. I don't drink soda and drink lots of green tea or other herbal teas.Iris
Suzy,It has been a pleasure corresponding with you as well.I can bearly make it through my physical routine, let alone any other type of exercise. I finally realized that things that I could do 10 years ago are no longer an option for me now. I used to love to do Tae Bo before I showered and got dressed to go to work. It helped me focus and helped these poor old bones and muscles get ready for a busy day!It is amazing how we must learn to adjust to changing circumstances in our lives.It is really sweet of you to pass on the information from the doctors.I have search the internet for all kinds of suggestions with nutrition and other means of controlling this condition and I too, have tried to always have a healthy diet and healthy lifestyle.As far as the health issue goes, I fear that it will be a long time before any bill is signed into law. Too many issues involved.I do hope that eventually they will come up with some sort of workable plan that will satisfy everyone concerned.Best Wishes,Iris
Iris, we all are but one must apply reality. No matter what is proposed it costs money. When they speak of health care for all what health care, catistrophic, deductibles, just what. When they speak of Medicare cuts what? Medicaid and we get even more worried. Why I know first hand what those cuts mean. Now my mom is 94 and on hospice. She has a DNR order, I have spoken to her doctor and basically she wants to die without pain and suffering . Not much to ask. She does need care which 90% I give with little to no help from Uncle same, That is washing, cleaning her, feeding her. What I don;t like is when some hot shot doctor says to me about my mom, "hey she's old what do you expect" or "she has lived her life". Honor, respect, Christian values that is what we expect, especially from self proclaimed Christians. No easy answers but if we leave care in care they will be answered.Dear Robert,I am sorry that Mom is in hospice and that she has an uncaring physician to boot!We have spoken in the past on issues concerning caring for elderly parents and we both know from personal experience that talk is cheap and only those who are actually involved feel the full force of caring for our loved ones.Yes, I do agree with your comment about everyone being involved but something has to be done.I just hope that some sort of plan materializes where we can have a choice between gov't and private but I still feel that if private would have to be more competitive if there is another option available.My heart goes out to you on a personal level for your frustration and your dealing with the insensitivity of the physicians around you concerning your Mom. It is never easy watching someone you love die and I agree, she deserves to die with dignity.My prayers are with you and your familyIris S TaubParkland, FloridaJumping in here, Robert: We have my mom-in-law with us in home hospice and they send someone 2-3 times a week to bathe her and change the sheets. Do you not get any of that help through hospice? She is 90 and may be doing better than your mom. My thoughts and prayers are with you, friend. ~ Jean
Iris, it is good to see that you are discussing these issues on-line. I wish you all the best with your situation, which surely is not easy. So glad you keep on writing.
Hi Jean,I think you might be confusing me with Robert. His mother is in hospice.I can tell you that my mother died almost four years ago and we brought hospice in and she died in her sleep at the ripe old age of 96. They were caring and made her comfortable. Unfortunately, like in Robert's case, that is not necessarily the case. My beautiful mother-in-law died in a nursing home that we were not pleased with and did not treat this kind and loving person with the respect and dignity that she deserved. She had a massive stroke and could not speak. Unfortunately she had an HMO with limited choices for nursing homes and the one we placed her in was rated one of the best. I would hate to see how the other's rated. My daughter and I were there every day to make sure that she got the best possible care available. We were sort of speak her voice. There were several battles that I fought on her behalf getting physical and occupational therapy involved when they literally wrote her off, because she could not communicate with her. We were so frustrated that we were in the middle of getting rid of her HMO and signing her up with Medicare so we could transfer out to another nursing home facility. Unfortunately, she died a day before she was to be transferred to the new facility. What broke our hearts is that she died so young. She was only 78.What people don't understand is that depending on the type of insurance that they choose, not all facilities accept all insurances so keep in mind that before you commit yourself to any insurance whether it is private, HMO or PPO, do your homework and make sure that the facility you want is listed on their in network plan. Unfortunately, there is no guarantee that if it is listed when you sign up that they will still be listed from year to year.Many facilities change their minds about accepting certain insurance programs and may or may not choose to continue working with that company.More than ever, we need a public option so that everyone has a chance to get coverage and at the same time, will force the companies to be competative with their rates. Let's face it, if there is no competition, they call the shots and they can increase their rates without notice. Like I said before, it is really everyone's problem because you never know when your employer will decide to cut benefits or opt for a cheaper plan that might not be the right fit for you and your family.
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