Who’s in Charge?

Managed Health Care…need I say more?

It continues to boggle the mind how an insurance company can think that they know what is better for a patient than a doctor!

I found this quote today, in Wikipedia. (Not a fan of Wikipedia, but this hits the nail on the head!)

"Unlike traditional indemnity insurance, an HMO covers only care
rendered by those doctors and other professionals who have agreed to
treat patients in accordance with the HMO's guidelines and restrictions
in exchange for a steady stream of customers." (Bold italics mine)

And there is the problem. Unsuspecting souls who are stuck with an HMO all of a sudden find themselves stuck in a vicious circle. The doctor that they have to see has already agreed to follow the insurance guidelines and restrictions in regards to their health. So basically, the doctor has already agreed to let the insurance tell them how they can treat; or some kind soul stated, what they will pay for. Either way, the result is the same.

Here's a little story: My husband lost his job in October. We managed to hang on to our private insurance for a couple more months, but by January, we were out of the funds to pay for COBRA. As a family of 8 with minimal income, we qualified for Medicaid. Medicaid wasn't so bad; at least they paid for the medical bills and prescriptions. But then, we were *flipped* to Health Plan of Nevada Medicaid, and all of our problems started.

Let's see; for me, it means that I have had to jump through hoops with flames just to get treatment. It also means that we are very limited in who we can see; and if they refuse to treat you (as in my case with a long standing wound), you have to go through more hoops in order to get the insurance to approve you to go somewhere else. Lucky (or not so lucky) for me, I had an actual case of medical neglect going on and amazing doctor (outside of the plan) who was willing to yell and scream and do whatever he could to get me treatment. If finally worked. The only reason I was able to have this doctor was because Medicaid had already approved my surgery with him and then I was flipped that same week, which enabled me to keep my surgeon outside of the network. It is he who has battled for my care, not the HMO doctors or the insurance.

Then there's my son. He's been seeing a doctor for a year now and is on some medication that is working for him. He was *flipped* in March. Medicaid paid for his medication, but now that HPN has taken over, they have decided that he does not need to be on it. They have also decided not to allow him to see his specialist, but instead he is stuck with the primary who has no history with him. We can't see the specialist who has been treating him unless we have a referral; the insurance dictates whether it is necessary or not and they also dictate what kind of meds they will pay for. This has been going on for two weeks. He is now out of medication that will cost us $200 each month and the only one that seems to care is the doctor that he can't see.

Then there's my daughter. She has endometriosis. Endometriosis can NOT go untreated. We went through several surgeries, specialists, etc, just to get her diagnosed and under control. HPN has no specialists in their plan that treat teenagers. We've gone back and forth between insurance and primary care. Insurance says she can see a regular ob/gyn because of her medical diagnosis, but they don't have a specialist listed that she can see. But, there is a waiting list to see the doc, and first she had to see her primary. Which she did. In the meantime, she needs her meds, but they can't come from the primary doctor, they have to come from the specialist and it is has to be an approved med. So, in essence, she can't have her medication to keep her endometriosis at bay because  of ridiculous insurance plan rules and regulations. We did manage to get some samples for her for a month, but the doc that she can see has a waiting list until the end of May! You would think it would be cheaper and make more sense for the insurance to just let her see her specialist that has been treating her, but then, the insurance would actually have to make sense, and we know that just isn't possible!

What they just don't understand is that they are messing with my children's health! Since when did it become OK for these insurance companies to become the doctor's? And are these doctor's so desperate for the business that they will accept whatever the insurances tells them to do?

I understand why doctor's refuse to participate in HMO's. They want to be able to treat their patients without some big company telling them what to do. I get that. What no one seems to understand though, is that it is the rest of us that are suffering. In my opinion, we need to get rid of managed health care. It certainly is not helping my family. And I'm a fighter. I spend more time on the phone trying to get their needs taken care of. Most people don't have the time or energy and just accept it.

I'm tired of accepting it. It sure would be nice if those who think they are doing what is best for us would actually take the time to listen and really be interested in DOING what is best for us.

Ok, rant over.