Thursday, March 31, 2011

Put Up Your Dukes

Before I begin the actual post, do I need to explain what "dukes" are?

Just in case someone is thoroughly confused, dukes are your fists.

Feel free to leave a comment thanking me for expanding your vocabulary this morning.

I am in a battle with our health insurance company.  (thus the reference to "dukes")

It seems like I am always in a battle one way or the other with a health insurance company.

When Ryley was diagnosed with diabetes 12 years ago, I discovered the ugly side of health insurance.

Oh sure, they're so pleasant to work with as long as you are incredibly healthy and only see the doctor once or twice a year, say for well checks or school physicals.  And maybe they'll still be nice if you get sick once or twice a year, but only if it isn't anything serious or chronic.

But once they discover that you might be expensive to insure, things become a little tense.

We had one health insurance company actually assign three deductibles just to Ryley - one for prescriptions, one for durable medical equipment, and yet another for doctor visits.

This sounds so nice and easy to keep things filed but it also ensures that we would never meet a deductible, therefore they would never have to cover 100% of anything.

And here's what really gets me going.

Health insurance companies often have employees who know nothing about health making medical decisions for my family.

A prime example of this:

Our health insurance provider actually called Ryley's endocrinologist to clarify coverage.  In the course of the conversation with the doctor, the employee (knowing that Ryley has Type 1 Diabetes because it's written on every form I filled out for them) actually asked, "So how long will Ryley have diabetes and need to continue seeing you?"

Umm.... excuse me?

Type 1 Diabetes = Lifetime.

As in, no cure.

So it's in the hands of this employee to decide how many times a year Ryley should see the endocrinologist and how many times a day she should check her blood sugar because they only want to cover the exact amount of test strips she'll need - no more and no less.  Because if we got extra strips, we might begin a highly lucrative black market business.

Please.

What really can make me crazy about this is that study after study shows that diabetics who get good medical care and see a doctor regularly have far less complications in the future.  Therefore, they cost the insurance companies less money than if they lose their vision or develop neuropathy when they're older, to name a few possibilities.  So sending a few extra test strips ought to be a good thing and a person shouldn't be treated like a criminal for making that request.

My current battle involves Lily's care.

Like diabetes, therapy for autism is an ongoing process.  But again, studies show that early intervention makes an enormous difference in the lives of these children, some even losing their diagnosis and progressing along like a typical child.  Therefore, spending a little more money now to save lots of money in the future should be considered a good thing.

But it just doesn't work that way.

You know, I used to be the kind of person who was intimidated by medical specialists, hesitant to speak up or disagree with the "experts".

Not anymore.  I take my role as advocate very seriously.  No one on earth is going to fight like me for my children.

So for now, I'm lacing up my boxing gloves and stepping into the ring to get Lily what she needs.

It's go time.

2 comments:

  1. I have boxing gloves in pink if you wanna borrow....just sayin'


    But seriously....you go girl...:)

    ReplyDelete

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