WARNING: the foods we cook for Abby are safe for her, but not necessarily for everyone. Please confirm any ingredients are safe for you before using in your diet. Food Allergies can kill and the best policy is complete avoidance. Read this post for more info.

Friday, January 6, 2012

I don't understand my Health Insurance-

One of the topics most of us in the Mito World touch on pretty frequently is Health Insurance.

Some of the policies they have just don't make a lot of sense, and in some cases cost the health insurance is more in the long run.

Example- We have tons of allergies in our house and lots of oddball allergies. Most of us have asthma triggered by allergies. We use the inhaler Xopenex. I try to keep an inhaler in the car, in my purse, in the girls purses- we just have no idea when we will be exposed to a trigger. At times we can go months, and we have periods where we seem to react to everything. Our insurance will only cover 2 inhalers a year. They feel if you need more then 2 emergency inhalers then you need to be on other medications for asthma too. This is ridiculous. We don't need daily medication. Daily medications like a steroid based inhaler can cost the insurance over 200.00 a month! Also, they will cover an unlimited amount of Xopenex for the nebulizer- so in one breath they say if we need more then two inhalers a year we are not caring for our asthma, but in the next breath they give us the same medication unlimited just in a different form. What is the message here? I think they are idiots. They must make deals with the pharm companies- what else makes sense? Do they really think I need 200.00 of additional meds a months? (xopenex inhaler costs 50 bucks out of pocket give or take) If I put inhalers everywhere we need them in the house and cars and school we only need 4 a year- that is 200.00 over 12 months, but if I take the meds they think we need the bill would be 2500.00 a year and I would be over medicated and still need the extra inhaler for triggers. Also, why do they give us unlimited xopenex for the nebulizer? Surely that adds up to more then my 4 inhalers a year, if they justify the limit on inhalers by them saying our asthma is uncontrolled, would the same be said for the same medication given a different way? Do they think asthmatics should all stay home by their big old plug in nebulizer if they want to breath?

I have heard similar stories from many, many families- and some really scary situations. Recently a Mom talked about how her Mito child had very compromised nutrition and their labs showed poor nutrition, but the insurance won't cover any interventions until the child has lost 20 pounds. Seriously? You don't have to be anorexic to warrant concerns about nutrition. I know I have been reading lots of articles recently about how many obese Americans are in some stage of mal nourishment(2012 the War on fat)- they have proven that a poor nutrition status is far more damaging then being too thin or too fat- especially in a child that needs proper nutrition to grow and develop.

Even the wheelchair for Abby did not make a lot of sense. They did cover the majority of her beautiful chair. One of the features they would not cover was the straight up lift- it allows her to go high enough to get into a cabinet in the kitchen, or be able to reach her own groceries in the store, or grab a book at the library- without it, she would have to depend on the kindness of people around her to make her life closer to functional- Isn't the purpose of the wheelchair to give her the ability to lead the most normal life possible? To me it is a no brainer, but to the insurance company I guess they want to make sure the user of the chair is reminded they are disabled- why else would they deny something so essential?

There are far worse situations I have heard of... and it leaves me worried. So far for the most part our insurance has been quite good to us. I worry though as Abby's health needs become more complex, what battles lay ahead?

As there is a need for Medical Schools to get their act together and teach Drs. about Mito, there is also a need for Insurance companies to learn about the needs of Mito patients. Mito patients need very different care, and I hope if the insurance companies understood they could SAVE money in the long run by covering certain needs that they would be more willing to provide the coverage.

I don't see it happening any time soon though- but I can hope.


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