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teacherrefpoet

The husband's perspective...

When I called the insurance company after Swankette was in hysterics, I got the same woman she did. She tried to sound soothing, to say that she's understanding, that she wants to help us and the baby, but that she couldn't give us the drug because it was a fertility drug. I asked her...without losing my temper even once, even though I have never been angrier than I was at that moment...I asked her why a doctor would prescribe a fertility drug to a pregnant woman. She gave several different non-answers. I asked her if she believes pregnant women take fertility drugs. She gave more non-answers.

Only after I politely followed this line of questioning for 5-10 minutes did she agree to let me leave a voicemail for the insurance company pharmacist. He called back and gave approval.

A couple who is less savvy, less persistent, less knowledgeable, or less willing to navigate the Kafka novel that is the modern insurance company may well have lost their baby. And the insurance companies have no reason to give a damn.

Why?

Because, for the profit-margin reasons that Swankette gave above, it is the JOB of insurance companies to deny care.

I'll repeat that. It is the job of insurance companies to deny care to as many people as possible. The more people they treat, the less profit they make.

I try not to get angry at the woman. She's not evil. It is her job to help the company out by saying no to as many people as possible. It is the current system that is evil. It values profit over health.

So please, please don't tell me that a government plan will cause evils--unless you've got something better than the status quo--something not based on profit.

Because if someone with our Cadillac-level of care had to go through this, then there's a problem--and that's without even discussing the 45 million who don't have insurance.

(Want more evidence the system is evil? Listen to Act Three here (it starts around the 37 minute mark): http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1308

It's impossible to listen to this without thinking of the word evil. But guess what? Under the current system, there but for the grace of God go any of us, insured or uninsured.

Meem

"A couple who is less savvy, less persistent, less knowledgeable, or less willing to navigate the Kafka novel that is the modern insurance company may well have lost their baby. And the insurance companies have no reason to give a damn."

Amen, brother!

In one of my audiology classes, a parent of a child with a cochlear implant came and spoke to our class. She told us that when filing a claim for the insurance company to pay for the implant (so that her child could HEAR, for Pete's sake), it was POLICY for the insurance company to deny the claim THREE TIMES before approval. Same goes with subsequent care needed after implantation.

I'm sorry. That's just plain wrong! A family is already caring for a child with hearing loss, shuttling them to audiologist and likely speech therapy appointments, and they're supposed to find the time to file claims THREE damn times? The insurance company is banking on the family giving up and not pursuing coverage. They figure learning sign language is a heck of a lot cheaper, and certainly not covered, no matter how many claims you file.

Rarrrrr.

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