Wednesday, November 26, 2014

ACA in Action

My parent is in the throes of a prolonged severe asthma episode. While they've had asthma for a while, this is their first bad flare. They don't have the arsenal that I do. No nebulizer. Hardly any meds and what little has been prescribed, the insurance company refuses to cover.

They finally got into a pulmonologist today who confirmed it's bad. My parent needs a nebulizer, but with the Tday holiday, has no way of getting one any time soon. The prescription has to go to the PCP and the insurance has to review it, a process, which for medications, has taken two weeks previously. (And they said no.)

The doctor is already concerned that my parent will need to be hospitalized.The inability to obtain the prescribed medication and medical equipment in a timely fashion makes it seem like a done deal.

I told my parent that they do not want to end up in the hospital if they can avoid it. I'm going to overnight my nebulizer on Friday (we already missed the last UPS truck today) as I'm pretty sure I'll be faster than the insurance company.  (I don't need it unless I'm in the middle of a flare, which I'm not.)

Meanwhile, I've urged my parent to put the word out and see if anyone can loan them a nebulizer for a few days. They need round the clock treatments if they're going to have a shot at avoiding more medical care. And steroids. And antibiotics. And everything else.

"Sit and do nothing," I advised. "You've got a four day weekend to rest and see if you can get ahead of this. If you feel worse, go straight to the ER."

"That's what the doctor told me."

"Good. Listen to them."

I was happy when the ACA passed. I recognized it was an imperfect bill, but I hoped it would lead to something better. However, right now, in practice, it is extremely flawed and serves profit before patients.

I realize some of the problem is the holiday and just bad timing, but my parent and I already know from previous experience that this particular ACA health plan denies claims as a general rule and their approval process is so convoluted and bloated, patients either give up or pay out-of-pocket (as my parent has done).  It feels like The Rainmaker by John Grisham. 'If we just say no long enough we're only out the ten bucks an hour we pay to the admins!'

The ACA serves as a money funnel to insurance companies, but not much of it is coming back to the patients.



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