You are more influential than you think

War is a nasty business. However, there is usually some justification or belief that a greater good will be served by those who fight the battles. When a war is fought nation against nation, thousands, if not hundreds of thousands of people are involved in the effort to garner a win for “their” side. Money is poured into the effort and speeches are made in support of the choices being made.

Historically speaking, most wars have an element of David vs. Goliath.  Someone, or some entity, is usually better financed or has more lawyers but the other party usually has the moral high ground. Hollywood is full of movies redolent with this message. “Philadelphia” is the movie I think of when my own David vs. Goliath battle threathens to overwhelm me. Tom Hanks’ portrayal of the tragically heroic attorney with AIDS – a disease now classified as a chronic illness, helps me try to keep perspective on my medical battles.  

In the last several months, I have been dragged into a number of skirmishes with my health insurance company. My personal military campaigned kicked off with a denial of service letter sent to me by my Medical Insurance Customer Service (MICS) department.  I launched my  first attack with help of my physician’s medical assistants.  Salvos were fired – I wrote down copious notes about who I talked with and what they said. When the medical assistances moved into forward position by asking the same questions I had asked in order to verify benefits, the MICS were unable to provide consistent answers and fell back to placing the calls on hold for ten to fifteen minutes at a time.  

Months have gone by with some battles lost, others won but overall I have been gaining ground. My troops have increased to include my physicians, their nursing staff and an untold number of medical clerics and assistants.  Unfortunately, there have been causalities. The one that makes me the saddest is the loss of my hair. Under extreme stress, my hair falls out. Earlier this year, it had started to grow back. Since July, when the opening shots of this battle were fired, it began to fall out again. 

Why fight? Why lose hair, have increased anxiety attacks or short term memory loss due to extreme stress? What could possibly be worth fighting about at this level of intensity? It’s a little thing called a line item veto.

For those of you not required to know this kind of medical lingo let me quickly explain. A line item veto, also known as a “contractual exclusion” or the more innocuous term “general exclusion” is any medical treatment that an insurance company will not pay for, regardless of the condition. These exclusions usually include the a statement that says “except when medically necessary” but in my experience that usually has more to do with avoiding lawsuits than the actual care of patients.  

The line item veto is literally the bane of my existence. With so many mystery illnesses, plus a chronic illness, addressing issues of contractual exclusions and pre-existing condition has always been a way of life. When I was first diagnosed with Type 1 diabetes, blood glucose meters were a line item veto. Now blood glucose meters are given away for free and the testing strips they come with are covered by ever insurance plan in America. 

My current line item veto war has many facets but here one of the more compelling examples:

·         My current health insurance has paid $4,500 (and another several thousand in Dr. appt fees, X-rays and MRIs) for a bone growth stimulation machine because my bones continue to break but not heal.

·         The insurance company will not pay for the $35,000 (which includes follow up appts.) surgery that could alleviate the condition. Why not pay?  Because, like the blood glucose machine back in the early 1980’s, no physician could prove\ guarantee that the surgery will reverse the condition.

We have reached a point where a “Yalta Conference” of sorts has been scheduled. The insurance company has already spent over $10,000 to deal with my constantly breaking bones with more money coming due every day. After four months, my bones still aren’t healed and now my kidneys are failing at a faster and faster rate as my body fights off some unknown cellular army.

I’m pleased that I have been clever enough to maneuver and strategize my way into a state of negotiation with my insurance company but it has come at a price. Soliders who have actively participated in a war know that no one ever really wins. You can only hope that no one else will ever experience the nightmares you live with everyday.