Systems built by insurers to curtail health spending on expensive drugs are intended to prevent unnecessary care that drives increases in health insurance premiums. However, the policies often backfire on individuals and families.
Shortly after I shared the story of my family's struggle to obtain medicine for my 3-year-old son in The Washington Post, more than 200 readers wrote to us about their health insurance ordeals.
The stories Post readers told revealed the personal dimensions of this policy impasse - the daily grind of being sick in America. For most of them, their fight was not a one-time hassle, but rather the beginning of a lifelong burden - a draining, part-time job they never wanted.A month-by-month fight to manage Crohn's disease
Hospital, insurance company, specialty pharmacy, infusion place and the doctor. That's how many wheels were turning. I spent four hours a day. Just every day on the phone. They requested it. It was denied. We appealed it. I took a month's worth, and then we changed insurance. I had my blood drawn before the insurance change, and [my LDL] went down. I felt really good about that.
A continuous glucose monitor uses a sensor that's underneath the skin, and every five minutes you get a reading on your phone. I can pull it up now. I talk about the difference between driving at night with streetlights vs. headlights. You see how food affects her blood sugar, how exercise affects her blood sugar. You can customize your alarms - at night if she's below 70, it calls us. We bought it the week of Christmas, out of pocket.I know how to do insurance appeals.
During [the pandemic], the doctor who originally prescribed the drug retired. I had someone who filled in with me with one telemedicine call and successfully renewed the [prescription] one time. But the next time, something got gummed up in the process. I kept calling them and not getting any responses. This is the thing I never understood, how big a deal the paperwork was.
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