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My Struggle with Insurance Companies and Healthcare that is Broken

This may sound like a sour grapes post on my blog, but I must vent about how frustrated I am with insurance.

It is easy when one is not sick to use insurance in everyday life. Broken bones, and basic care is great. Having ALS means that much of my needed care is very expensive and not covered by insurance.  This is a common theme in the news when people confront a catastrophic illness, insurance companies want to drive care decisions to reduce exposure and cost.

In my case Humana has decided a few things for me that I'm not happy with.

• They will not pay for more than 12 visits of a home health nurse in order to keep me out of the hospital.  Staying out of the hospital should reduce cost to Humana but they don't care.
• I was prescribed an antibiotic recently. They paid a portion of my antibiotic, my portion was $500.00
• They would not pay for my ALS drug, which cost me $500.00/month (this is now generic which is affordable now) for over a year.
• They will not pay for an oxygen portable compressor so I can leave my house with a vent to visit a doctors office, they call this a luxury. $3000.00.
• They refuse to pay for technology to help me speak and use my computer, $750.00/month.

In fairness Humana has paid for a lot, but tell me in the list of items above could you afford these? Which would you do without?

I would give anything not to need insurance, I wish Humana could make a boatload of cash.  I did not do anything to get ALS.  I did not drink or smoke.  I exercised regularly and tried to eat right. Here I am  and others struggling to pay for these things while Humana pays big money to executives.

In 2011 Bruce Broussard the CEO of Humana, made 10.5 million in compensation.  That is 122 times my salary at my previous employer. Add in other executives and Humana is not a bad place to work.


I'm not saying I'm anti capitalistic, but when I see that kind of compensation and know that there are others like me trying to survive and have needs, I find it overwhelmingly backwards.  

I want insurance that tries to pay claims, not avoid them. Insurance companies are not the only root of the problem, hospitals are guilty of over pricing care, pharmaceuticals jack prices, and doctors run too many tests(over simplification ).

There is wide support for market based healthcare, but how are market forces helping me?

The Heritage foundation put out a report on repealing the Affordable Care Act. Below is the opening paragraph.

For a better life, Americans need a health care system that they, not the government, control. Consumers should have the ability to choose how to meet their health insurance needs in a free market for insurance. Taxpayers should benefit from a more efficient and affordable system for helping those who need health care but cannot afford it. Above all, patients, with their doctors, should make their own health care decisions free from government interference.

The important first step is to repeal the Obamacare statute that puts the government in charge of health care. The second step is to let the country move to a patient-centered, market-based system that focuses on citizens and not on the government. 

This report does not match up with the many struggling including me. 

To be clear, I don't want government healthcare either, but I just don't believe that for profit insurance is going to pay more claims over time.  I think its only going to get worse. Can insurance be market based? Paul Krugman makes a good point in his article that it can't be.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive.The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

I'm not sure what the best answer is but I know my struggle is real and the pundits and policy makers can continue to debate healthcare. I hope we can solve these issues so folks can get what they need in trying times.

Home

Hello friends,

I want to take some time to tell you about my last few months.

The week before Thanksgiving, we had a normal weekend, but overnight I went into respiratory arrest. The Georgetown Fire fighters and EMS saved my life.  It turns out that I had pneumonia and did not know.  I have been on a ventilator since that night. 

My goal has been to return home and get our family back together. My wife Kim has been at my side 24 hours a day at the hospital to help me.  You see with a tracheotomy I cant speak, and the ALS prevents me from mobility of even lifting my hand.  She has become my communicater. I'm inspired by her will and dedication to me.

My two girls have had the support of my fantastic family and friends. They however have had to endure the ups and downs of my life in the hospital and no parent with them. I'm very proud that they have tried to work hard in school and get through these trying times.

With the generosity and support of family and friends, financially and spiritually supporting us and with  God’s will I can report I am home.  Unfortunately I have been home twice and had to return to the hospital because of pneumonia.  I'm hoping I'm over that and can get stronger so I can do some work from home, and return a little normalcy to my life and family.

This has been maybe the most trying time of my life, but being home makes it worth it.  God left me here for a reason so I have more work to do.  My road is still difficult and I may call on you for help.