Personal Choice

Personal Choice.  It means a lot of different things.  In this country, our personal freedoms are taken very seriously.  In this blog, I am talking about having control over decisions about my health, as well as the health insurance company that goes by that name.  I think I could honestly rant about my insurance company and many like it on a daily basis but I'm choosing today.  Yesterday I basically spent 6 hours exchanging emails with my doctor's office, calling my pharmacy, and trying to figure out why it was taking so long to refill prescriptions.  I have come to the conclusion that for anyone with a serious illness, Personal Choice is the only insurance to have.


Obviously, I do not have Personal Choice, but it would make life so much easier.  Most people with a chronic illness or disability will be in the same boat as me (at least in the U.S.) and dealing with an HMO.  For ER visits: no problem.  For just about everything else: all sorts of problems.  I went to a few in-network doctors when I first got sick and I honestly think they caused more problems than they solved.  My general practitioner had no answers, did not refer me to a specialist, insinuated I was simply wanting drugs, and finally gave me the name of a surgeon who could see me.  That in-network surgeon did my first laparoscopy and because he did not report the extent to which I had endometriosis, my doctor did not immediately recommend surgery.  When I did finally have surgery for removal (with a different, higher quality surgeon), I was told that they were surprised how extensive the endometriosis was, as it was not indicated on my laparoscopy results.  The in-network surgeon also told me that should I decide to remove it, I should probably go somewhere else because it was beyond his skill level.  

My ob/gyn/women's health doctor who I go to now is not covered by insurance.  And I can see why.  The quality of care she gives is unlike any doctor I've seen from an HMO.  She treats patients like people.  She doesn't come in with charts from other rooms and she doesn't rush you out after 15 minutes if you still have unanswered questions.  And she is not cheap.  She is, however, worth every penny to me.  She has tried to prescribe me a few things that she believed would be beneficial (and she stays current on her research and her suggestions often helpful) that the insurance company claims it needs prior approval for.  Let's just call it what it is.  Prior approval = death sentence.  I do not know if those things may have helped me at a time when it was most needed, since a health care company's computer decided I didn't need it.  I have never met anyone at the health insurance company.  They do not know anything about my medical records, but I feel like I have not gotten the absolute best care I could have and it is not because of my doctor.  Ironically, while the insurance company doesn't want to cover anything... if I go to the ER, they cover everything.  So it is in my best interest to go to the emergency room for a paper cut.  The expensive meds they give you in an IV in the ER that cost more than anything I am prescribed... totally covered.  I totally should have considered daily morphine injections from the ER when this first started.

I do not believe an insurance company should have control over the quality of health care I am provided.  I do not believe that they should be able to veto a medication that my doctor thinks would be helpful.  I do not think they should be able to choose what hospitals I can and cannot go to for surgery or what type of physical therapy is accepted.  I can tell you from talking to more than one person at my health insurance company that they know so much less than I do about medications, doctors, in-network questions, etc.  I find that beyond irritating.  I call up my health insurance for questions about covered medications and not only does the person on the phone not know the answer (which I was really just calling to confirm) but he also does not know who he should direct me to talk to in order to find out the answer.

(I swear, I'm not bitter...)

This rant could continue on for, I believe, several hundreds of pages.  I could elaborate on every sentence I've written so far.  But what got this particular rant started?
1. I realized last week as I counted up my pills that I did not get the same amount of pills as the bottle said, so I ended up being short-changed, with nothing to do about it at this point because I didn't catch the mistake for a couple weeks, as I am not in the habit of counting all of my pills.  Because of that, I had to refill the prescription early, and the earliest I could get it prescribed was for Wednesday, regardless of whether or not my pills will run out Tuesday.  I know that might not sound like a big deal to you but to me, the fear of pain is a real thing and not being in possession of the medication to make it go away, even for a day, is a frightening prospect.
2.  At my last doctor's appointment, we decided I would get my hormone shot every two months for a while instead of every three months until my pain was manageable again and my life stressors could decrease.  Well, even though my old prescription had run out, the insurance company will not refill a new shot until 3 months after the old one because that is what it said on the old prescription.  Doesn't matter that this prescription is for a more frequent shot, it matters what the old prescription said.  That actually bothers me less than the fact that doctors should be able to adjust medication as needed to fit a patient's needs.  If she wrote I should get a shot every three months and then later decided I should get it every week, as long as it is legal and ethical, and has a valid prescription, why is it anyone else's business??  If anything, I would imagine this leads to doctors over-prescribing because they have no ability to change their minds.  That is ludicrous.  For chronic illnesses, especially, the treatment is fluid and a company should not get to say it's not.
*The hormones control the endometriosis.  The production of endometriosis can cause pain.  I have had problems stretching all the way to three months with one shot without breakthrough pain.  Therefore, my doctor decided to increase the frequency of my hormone shot.  It just seems so logical!*

(All this and I haven't even gotten to the incompetence of some of the people working at the pharmacy.  I guess that will hold to another post).

Personal Choice, people.  And I'm not talking about the name of the insurance company.