One Woman's Journey
Through Diabetes and Obamacare
You first question
might be, “why should I care?” My answer is simply that $400.00
of YOUR tax dollars are being given to an insurance company every
month for me alone. Most of the recipients of ACA policies are
getting subsidies because we are the population that were not
insurable before Obamacare. We are the out of work, the too old or
sick to work and in the states that have refused to expand Medicare.
The other reason you should care is you are probably next when your
nice, high paying techie job gets shipped overseas or to a Red State
where they can get a tax free card and labor at a fraction of the
cost they are paying you because the standard of living is so low and
everyone is getting food stamps and welfare. With the portability of
technology, companies can move their manufacturing, tech and offices
several times a year to take advantage of willing politicians who
need money for vacations, cars, low interest mortgages, credit cards,
fancy dinners, clothes, etc... MEME's on TV so uneducated people vote
them back into office.
My little journey
began when I got my insurance card and I called my regular Ear, Nose
and Throat doctor for an appointment because he was listed on the
insurance web site as taking their insurance. Because my regular
doctors were listed on the web site, I had signed up of the CIGNA
policy through the ACA. What I did not know was there were two grades
of policies, normal corporate and ACA. CIGNA was publishing their
corporate list of doctors, not their ACA providers. You didn't get to
see that list until after you had a card and the Federal Government
had crossed their greedy little palms with gold AND you managed to
practically hack their site because there is no really easy way to
discover who takes your policy and who doesn't. Each doctor of their
over 500 has to be individually accessed to find out if they take the
ACA policy. That takes hours. Trust me, I know. I've done it.
I was actually
screamed at in the doctor's office because I had an ACA policy and
had to shell out $400.00 with a maybe they will pay for the tests as
I was, red faced, finally shoved out the door. They never filed a
claim for the tests.
At the gynecologist,
I had been told they took the ACA policy. Yes, at this point I had
not managed to find out from the CIGNA web site who was who so I was
asking the doctors before I made an appointment. I had found a small
lump on my breast as needed a mammogram. You need a prescription for
one. When I got there, still half scared to death, I was told they
didn't take the ACA policy but if I paid for the exam it would be
$175.00. If they filed for reimbursement as an out of network
provider, CIGNA would demand I pay them $250.00 for the visit.
However, they would have the lab bill CIGNA and they would get paid
for the PAP smear. I would have to find my own Mammogram facility
that took ACA policies. Fortunately, there was one a few blocks away
and now out $575.00 that I now had on a credit card, I made certain
my hematologist, took ACA policies before I showed up in that office.
Much to my shock as
I had been treated pretty much like last week's bad garbage, I was
treated nicely there, but it was downhill from that point and this is
what you really need to know.
On Friday the 13th
in June, the hematologist's office called hysterical, demanding I get
to an emergency room right that moment. The lab they sent my blood to
had called frantically. I had a blood sugar level of 500 and was in
diabetic ketoacidosis (DKA). By the time I reached the ER, my blood
sugar was 650 and I was really in diabetic ketoacidosis. The ER
wanted to put me in ICU because they could not stabilize me. I
continue to protest as I knew the insurance wasn't covering the ICU
and finally when I was out of ketoacidosis around midnight they
agreed to place me in a sparsely populated ward where the nurses
could check me hourly.
I have back and hip
injuries from a car accident 40+ years ago and the mattress was
nothing more than a foam topper normally placed on a mattress now
residing on a stainless steel table in a plastic cover and to add
insult to injury, was designed with multiple little spikes that the
sheet settled into when left at rest. I managed to pull three
straight back chairs and a couple of pillows together to sleep on. It
was either that or the floor and who knows what lurked down there. I
was ready to go home the next morning on Saturday and the hospital
refused to release me.
It works this way.
This is from the Mayo Clinic:
“Seek
emergency care if:
- Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
- You have ketones in your urine and can't reach your doctor for advice
- You have multiple signs and symptoms of diabetic ketoacidosis — excessive thirst or frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion
Remember,
untreated diabetic ketoacidosis can be fatal.”
My glucose was 650,
I had no doctor and I had never been treated for diabetes. The
hospital was not risking a lawsuit if I dropped dead. If I signed
myself out, they could not give me medication and the doctor
estimated I would be dead or in a coma within 24 hours with no
medication. Thus, they found an air bed, slightly better than the old
bed of nails....by-the-way I have lain on a bed of nails and it is
more comfortable than the first bed....13 pillows and I was set to
try another night.
In came a kid, okay
maybe she was 18 or 19, to give me my dietary training which
consisted of a few pages copied off her text book and “there is an
app for that.” Don't exceed 15 unit of carbs a day. Okay, what is a
unit? Is it a gram? Oh, there's an app for that. Just type in the
restaurant's name and bagel and it will tell you. I don't eat out and
I'm a vegetarian. This was not going well because I knew more about
nutrition than this girl and her app. After she left, in came a
doctor, who left her card and told me to come and see her as soon as
I was released. Highlight that sentence because it is a scam.
Sunday, I still can
not get out of the hospital so I called my husband and told him to
bring my laptop as I was really getting bored. By the time he got to
the hospital, I was suddenly being released. It was 4:30 PM on SUNDAY
and they were phoning the insulin prescription into the pharmacy by
my house. The nurse ran in to show me how to inject myself and with
me protesting that the pharmacy was closed, they gave me a written
prescription at 5 and asked if I was feeling well enough to walk out
of the hospital and scattered like rats deserting a sinking ship.
George turned to me and said, “What just happened?”
I answered, “they
probably just found out the insurance company isn't going to pay.”
When I am right, I am right.
We had to find an
all night pharmacy. Walgreens doesn't take ACA insurance so we had to
go to CVS. The original CVS that had the prescriptions phoned in to,
marked them filled so the second one could not use the insurance and
I had to pay $277.00 to get the bottle of Lantus from them with the
promise I would get the money back. Yeah, sure....I have not only
paid for that bottle but $150.00+ dollars copayment for a bottle I
never got. I was too sick to argue as my glucose was no where near
normal or controlled.
Monday, I got to
play run to pharmacies as it turns out the pharmacy that marked the
prescriptions filled, didn't even have the medicine to fill them and
I had to return to the all night pharmacy across town and that is
where I paid for the same medication twice while getting it once. Not
only that but now it was Monday and CIGNA was balking at the bill. I
had to have their meter instead of the cheap one from the hospital
and close to 10% of this brand's test strips and even lances are
defective. At a dollar a test strip and only being able to get
exactly the number ordered for exactly the number of tests for 30
days, that leaves me without tests for 2.5 days.
Tuesday my blood
sugar exceeded 200, normal is below a 100, and I called the doctor on
the sheet I received from the hospital and whose card I had. The only
person I could reach was the physician's assistant and she told me to
come in and get a sample bottle of insulin or she would phone in a
prescription for short acting insulin and I could discontinue the one
pill I was taking. This bottle of pills was close to $200.00 in
copayment and I had taken one of the 30. Growl....but I got two
bottles of insulin and a couple of packages of needles and really
important badly copied piece of paper to write my 4 times a day
readings on. I should call on Friday for an appointment. Waiting at
home in the mailbox was the letter from CIGNA stating they were
denying the whole claim as my condition was not life threatening.
Please read the quoted part from the Mayo Clinic again. This is a
doctor signing the denial. The hospital appealed and on Wednesday I
got a letter stating they would pay for 23 hours of observation but
every item of care I received in the ER would be individually
reviewed and the other 2 days of care and stay were denied. Remember
here that the hospital refused to release me.
I waited until
Friday and called the specialist with my little piece of nice filled
out paper and I was told I really wasn't a patient and they had only
given me the insulin as a courtesy to the hospital, the doctor was on
vacation and to call my primary care physician and get a referral. I
didn't have a primary. I just got insurance. I haven't been able to
afford a doctor in three years, however, my hematologist had
recommended someone and I called them.
In the mean time, I
am running out of syringes because the insurance only covered a
couple of bags based on 28 days of one injection a day and now I am
getting 4 injections a day. Back to the pharmacy, where I have had
such fantastic experiences, and I get to buy 2 bags out of pocket but
not worry, my prescription of syringes was going to paid for on the
5th of July. I show up on the 5th of July and
they deny anyone ever said that. However, at home I find the print
out from the pharmacy and clearly printed is to return on the 5th
of July. By that time, I had bought another 6 bags of needles, full
retail and I guess I should consider myself lucky they let me buy
them.
I couldn't get a
doctor's appointment until August and I frantically explained the
situation to the General Practitioner's . No problem, they set me up
with a physician's assistant who was very helpful the next week in
showing me how to adjust the Lantus, which is a long acting form of
insulin, but when it came to the pills or the short acting, they were
not comfortable dealing with a new diabetic. That was easily
understood. They are general practitioners, not specialists. So, I
left with my referral thinking I had met all the requirements to see
the specialist.
After I lost it on
hold and George had to finally take over because I was almost out of
insulin, he spent all afternoon finally getting the specialist's
physician's assistant to phone in the substitute for Lantus CIGNA was
willing to pay for and for the pills and the 2nd insulin
and more needles and you can call back in 2 months and MAYBE get an
appointment. I was livid.
So I wasn't
surprised when I spoke with a second doctor who suggested I go to the
specialist's office and refuse to leave until I saw the doctor. As he
put it, you don't have your diabetes under control and you have no
way of even knowing if it is under control. You have not seen a
doctor since you were released on the 15th of June. It is
the 16th of July. You have no real training in how to take
care of yourself. This doctor is never giving you an appointment
because of the ACA insurance. You have to force them to see you.
Yup, I can't think
of better medical care I can get than the kind you have to stage a
sit in at the doctor's office to get. Perhaps holding a gun to the
doctor's head would work better. Of course, she is on permanent
vacation so my options would be the receptionist or maybe physician's
assistant.
It works this way.
To get the government money which happens to be YOUR TAXES, the
insurance company has to demonstrate that they have X number of
doctors in every specialty based on the population of your area. So,
they sign doctors up and put them on the web site as accepting new
patients. However, since the GOP/Tea Party gutted the ACA before they
voted for it, there is no way to punish the anyone if no one ever
bothers to see a patient and no way to actually check. I'm sure the
bought doctors get something in return like free vacations/seminars
in 5 star resorts in the Bahamas or Mexico, low interest loans, free
samples of medications they shouldn't have if they need a boost to
get through the day (remember I worked for a psychiatrist for 10
years and saw all the addicts with MD's and wondered how they got the
drugs. You can't write yourself a prescription for a narcotic) and
plenty of perks. Whatever they are giving them is a drop in bucket
compared to what they are getting from the Federal Government in
subsidies that YOU are paying for. I'm paying good chunk of change
out of my pocket to the point I am considering dropping the policy
and paying the fines. It may work out cheaper.
Meanwhile, these
GOP/Tea Bag doctors think they are making off like bandits with no
regard for how many people's deaths they cause and as a plus think
they are gutting Obamacare which they have been sold a bill of goods
is going to put them in the poor house where the rest of us now live.
The only people making out like bandits are the insurance CEO's who
will be getting billion dollar bonuses and perks this year from all
the money the ACA just dumped in their pocket and they are used to
killing people so no biggie on their conscience if they actually have
one. Oh, don't forget the GOP/Tea Party politicians drunk on power
and/or booze who will be reaping those huge campaign contributions
which are again, a drop in the bucket compared to the money the
insurance CEO's are getting. The politicians never could do math,
anyway.
My claims are still denied and here is the treatment protocal for my diabetes just in case you think everyone including was over reacting:
'
My claims are still denied and here is the treatment protocal for my diabetes just in case you think everyone including was over reacting:
'
Medical Treatment
- Fluid replacement and insulin administration intravenously (IV) are the primary and most critical initial treatments for diabetic ketoacidosis. These therapies together reverse dehydration, lower blood acid levels, and restore normal sugar and electrolyte balance. Fluids must be administered wisely - not at an excessive rate or total volume due to the risk of brain swelling (cerebral edema). Potassium is typically added to IV fluids to correct total body depletion of this important electrolyte.
- Insulin must not be delayed and must be given promptly as a continuous infusion (not as a bolus - a large dose given rapidly) to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body's cells. Once blood glucose levels have fallen below 300mg/dL, glucose may be co-administered with ongoing insulin administration to avoid the development of hypoglycemia (low blood sugar).
- People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit.>
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