#Medical Insurance Coverage

[davidaugust]

Ah, insurance. 🩺🤑

[supercantaloupe]

two tries on two separate days and i STILL can't get ahold of the new endocrinologist's new patient scheduling assistant argh. hopefully they actually call me back this time. on the bright side i did manage to get through to billing (despite their horrible phone tree and even more horrible connection, it sounded like they were speaking through a frayed wire) and get them to update my insurance information and actually bill my insurance for my recent telehealth visit bc there was no way in hell i was gonna pay their upfront unadjusted cost for a thirty minute zoom call with my pcp without them at least TRYING to ping my insurance first

[cptn-sulu]

why did we invent money

[mirdaniaa]

People love to pay a monthly premium for insurance and not know how to use it. God bless, you are all so stupid

[lucky-clover-gazette]

i have the type of adhd that makes me try aggressively harder until it consumes me when it’s extremely difficult to acquire medication, instead of giving up because phone calls scary

[infriga]

A kind of funny trend I've noticed is that many fanfic writers who write for fandoms that take place in Japan often aren't aware of the fact that Japan has universal health care. I've seen quite a few fics set in Japan with whump/hurt comfort plots that mention large medical bills as if it's taking place in America lol.

[thevioletcaptain]

the next customer to ask me "what's wrong with your eye?" is getting thrown into the sea :)

[tj-crochets]

Inexplicably just got two letters from Aetna asking for additional information for prescription drug prior authorization in the state of Florida. Couple of things wrong with that: - the prior authorizations have already been approved - I don’t live in the state of Florida and never have - the information it asks for is information I cannot provide, only my doctor can, and she’s named on the paperwork so they definitely know how to send her the letters - I’m not in Florida???? Why Florida?????

[marsixm]

i never ever complain about money bc i know im in an extremely privileged position bc my family gives me a decent chunk of financial support, and thats why i am always actually able to give to my friends and others in need, but the fact is if that disappeared tomorrow i make just enough money to scrape by at the current pace and my dad is a very confusing elderly man who is hard to get clear answers about anything from, so shit could just disappear tomorrow and id only find out tomorrow. it probably wont and ill probably be fine but i really can barely justify spending half my rent on a health insurance premium, the stupid enrollment period thing is closed or whatever (why is that even a thing?) and thats just. deeply frustrating. anyway this is a self reminder i need to start diversifying my income and selling shit online lol

[rivetgoth]

I have had some massive fucking wake-up calls the last few days between the post office refusing to give me my mail because of my preferred name not matching my legal name (I got it eventually, but not without the person at the customer service desk literally telling me baseless threats over it and being an absolute ass to me) and now last night being woken up with the most painful cramping I’ve felt in my fucking life, bad enough I think I might have ended up in the emergency room if the heat pad and naproxen hadn’t worked because I was literally doubled over and dizzy from it. I have needed to update my legal information and get a hysterectomy for YEARS now and it has reached a point that I cannot go on putting it off any longer. I am kind of nervous because it almost feels like starting from the beginning again trying to find a trans-friendly PCP and gather referrals and approval letters and get my finances in order and broach the subject with semi-unsupportive-ish family who will no doubt be unhappy about it, but at this point I am scared for my health and concerned about being denied access to things with my legal name not being updated so uh 2023 resolution has been decided for me by the universe, clearly. I am excited knowing that my uni has a name change workshop for trans people that I’ll be able to take part in coming up in a few months so that’ll be completed soon but uhhhh. Damn. 😬

[artemisiatridentata]

been waiting to hear back for a while on genetic testing I got done to see if I have the same extremely rare genetic disorder that killed my grandpa earlier this year, and finally found out yesterday that I do indeed have it. yippee or whatever 👍

[thebibliosphere]

I’ve got my tumblr inbox turned off so I really have to commend the person who actually emailed me to let me know they don’t like the things I’ve posted about the UnitedHealth CEO being murdered on their commitment to their beliefs.

But seen as how you emailed me from a dud email that appears to be bouncing back replies and I really wanted to address something you said to me about violence begetting violence:

My migraine medication, the medication I was given for my debilitating neurological disease that has gotten so bad I spent most of this year actively suicidal, costs $1300 a month.

My insurance covered it. But only because my doctors office went to fucking war for me because I’m a high anaphylaxis risk for the drugs the insurance wanted me to try.

Because that’s the thing.

My doctors knew, based on my documented medical history, I likely wouldn’t be a good fit for the “first line” of preventative migraine drugs, but because of insurance, I had to be given drugs that were contradictory to my other life threatening conditions, because otherwise insurance wouldn’t cover anything else.

I failed them. Spectacularly and with an anaphylactic reaction to one of them. And I was still warned insurance would fight me because I hadn’t tried the remaining drug they wanted me to try.

A drug which I would have to take in an ER waiting room because my mast cell disease is unpredictable but insurance wouldn’t cover in-patient treatment to let me try it safely under medical supervision.

Is that not violence?

Were all the times I was denied coverage for vital and necessary procedures that could have prevented my disabilities from worsening not violence?

Maybe not in the sense you mean. But I assure you it felt very much like violence to me.

Do I condone murder? No, obviously. But I’m also sick and tired of people pretending that what is happening to the American people every day isn’t eugenics through class warfare.

Violence begets violence.

It sure fucking does.

Maybe these insurance companies should have thought of that first.

[gingersnapwolves]

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ��that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

[anarchywoofwoof]

let's recap what we've learned about the United States in the last few days.

things that are terrorism:

allegedly shooting a healthcare CEO whose company generated more pure profit (not revenue, profit) in a year than the GDP of 94 countries, exclusively by denying coverage to people who pay for it

a 42-year-old mother of 2 using the wrong combination of 7 words during a heated conversation with a call center employee at a health insurance company who was in the process of denying her health coverage.

things that are not terrorism:

mass shooting in a Black church to incite a race war

going to a BLM protest specifically to kill protestors

a neo-nazi running over a crowd of people, killing a woman

targeting and killing 23 latinos in an el paso, texas walmart

killing 12 people in a theatre, shooting 58 others, rigging your apartment with explosives

a QAnon groyper killing 7 and shooting ~50 at a 4th of July parade

killing 3 people and shooting several others at a Planned Parenthood in defense of the unborn

stalking someone relentlessly and then killing them and their child despite months of the victim making police reports

any one of the 1,200 murders committed by US police yearly, the vast majority being minorities

tightening your border while ~100 immigrants (including children) drown every year in the Rio Grande

United Healthcare killing an unnknowable number of elderly people by using faulty AI to deny medically necessary coverage

Aetna killing a woman by refusing to cover her cancer care

Blue Cross killing a 6-year-old by denying her appendicitis surgery

Cigna killing a 17-year-old child by denying her liver transplant

the pharmaceutical industry killing half a million people with opioids in the name of producing revenues in 2023 that rivaled the GDPs of countries like Spain, Mexico, and Australia.

the United States killing 45,000 people a year because they can't access health coverage

make sure you keep this guide handy the next time you find yourself interacting with your insurance company or any other millionaire, billionaire, or an individual who is part of a protected class such as a CEO or president of a corporation.