A Battle With The System: Fighting For Treatment

Nine months ago my motility specialist gave me three treatment options. My digestive tract paralysis had progressed from my stomach into my intestines and colon and there just isn’t much they can do for that.

Option one– a specific medication –was quickly ruled out due to risks with another condition I have and the third option is not doable either, so we were left with one option.

Our one treatment option was IVIG therapy, or IV immunoglobulin therapy. This is a treatment that focuses on rebooting the immune system and can sometimes help reset some of the issues with the central nervous system. It’s used to treat immune deficiencies and other conditions that can lead to a weak immune system. For me, the goal is to boost my system in hopes that my digestive tract will be positively affected. There are no guarantees and it’s only about a 50/50 chance that it would make any difference at all for me, but it is our best and only real option right now.

It’s been nine months since we put the prescriptions in for that and I’ve been denied by insurance twice. My illnesses aren’t on their list of conditions that require IVIG for treatment and each round of IVIG costs $10-15,000, so it’s not easy to get approved for patients like me.

That said, this is my only option for treatment that may help me improve, not just keep me comfortable. Even if all it does is help me tolerate my tube feeds better and have less pain or nausea, it would be a huge victory. This is what my doctors think I need. So being denied the opportunity to try it is really upsetting; sadly, we see this happen a lot in the chronic illness community.

Our medical system is a money making business, so a lot of medications and treatments take pre-authorization, out of pocket co-pays, repeated appeals, and some are not covered at all. But for those of us with severe, chronic and progressive illnesses, this can make it hard for us to live any semblance of a “normal” life.

I am so thankful to have good health insurance, but the hoops I have to jump through and the delays in my care are extremely frustrating at times. My parents and I spend hours each month calling the insurance agency and calling doctors and pharmacies to advocate for the treatments I need. I’m lucky to have people who fight for my care when I’m not strong enough to do it myself, not everyone is that blessed.

If our doctors prescribe us a medication or treatment option that they think is vital to our health care, insurance agencies should not be so quick to deny it. The lives and well being of patients should be the first concern of every part of our medical system.

A Response to The AHCA From One of The Millions Left Behind

Yesterday the House Republicans approved the American Health Care Act—their replacement for the Affordable Care Act. Although it still needs to pass through the Senate, my heart, along with the hearts of many other Americans, was left very heavy after this vote.

Although Donald Trump claimed that his bill would provide health care for everyone while also leading to tax cuts and a better budget for our country, if you look deeper into the bill you will see that this is a blatant lie. The AHCA claims that it “maintains protections for people with preexisting conditions, with some important exceptions.” It then asks you to “see waivers below.”

The waiver section of the bill allows for state-level full repeals of Obamacare. Each state has the ability to apply for waivers to opt out of regulations and protections from the ACA. There are three main waivers for each state:

  1. Charge older people more than five times what they charge young people for the same policy
  2. Eliminate required coverage, or essential health benefits, including maternity care, mental health, and prescription medications
  3. Charge more for or deny coverage to people who have preexisting health conditions including but not limited to cancer, diabetes, and domestic abuse

Okay… so #1… aren’t we supposed to be moving away from inequality in America? Clearly this ageist fine print is harmful towards our senior citizens when in reality we should be taking care of our elderly, not robbing them.

#2…. Our maternity care is already extremely lacking compared to other industrialized nations, so why are we moving further backwards? We should be extending our maternity care and offering longer paid leave for both parents after childbirth, not taking maternity care away. As for planned parenthood, only 3% of their funds go towards abortion, so let’s not even talk about how ridiculous it is to defund them when they provide extremely important care to high risk women all over the country.

Our mental health system is already WAY too hard to work with. Individuals with severe mental health struggles are living on the streets, struggling to find homes and jobs, and trying their hardest every day just to get through the day. If someone with severe bipolar, depression, schizophrenia, paranoia, or a personality disorder is left without a support system and doesn’t have a treatment plan, it can be extremely difficult for them to succeed or even survive in this world. Why would we make it harder for them to get adequate treatment? Mental health is not at the fault of the individual, and we should not treat them like it is.

As far as prescription medications go, I can tell you I max out my insurance in a month or two max every year. I’m on 20+ prescription medications if you include all of my oral medications, tube medications, IV medications, infusions, and tube feeds. If I lose my health insurance, I won’t be able to afford these treatments and I don’t even want to think about what happens then.

#3.. okay this is where I really get heated, and considering I’ve already been typing up a storm, you’d better prepare yourself.

Let’s start with the quote from our good GOP friend, Congressman Brooks, “My understanding is that the new proposal will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done good thing to keep they’re bodies healthy. And right now, those are the people, who’ve done things the right way, that are seeing their costs skyrocketing.”

So basically he is saying that “good people,” aka healthy people, should pay less because they have “lived better lives.” Well, I am a sick person. I am a sick person who is likely going to be sick for a very long time. However, I am a good person despite being ill. Before getting sick, I was a good student, I volunteered regularly, I ate healthy and went gym all the time, I was an athlete, I got into a great college, I had friends. Now I cook for my family, I take care of myself the best that I can, I still volunteer as I am able, I write and paint and have a positive attitude about my situation. So, what makes me less of a person? I’m not trying to brag about myself, I’m just making a point. I know not all GOP congressmen and legislators are quite this dumb, but people with illnesses do not deserve to be treated with disrespect.

But chronic illnesses like mine aren’t the only ones that this bill considers “pre existing” conditions. Yes, my illnesses are pre-existing, but so are cancer, depression, anxiety, acne, and over 50 other conditions. What’s even more shocking is that rape and domestic abuse are considered pre existing conditions! Uhm.. excuse me? In what world is it fair to make the victim of a sexual assault pay more for health insurance than her attacker pays? What about the husbands who abuse their wives? What affect will these rules have on the victims coming forward? Will attackers pay more, too? Where is the equality in that?

What makes my life worth less? The fact that I have a chronic illness? Is the life of someone with mental illness worth denying them a psychiatrist? What if it costs them their life? Is a rape victim’s life worth less than that of their rapist? A domestic abuse victim less than their spouse? Is a special needs child’s life worth less than their sibling or classmate? Where does it end? Where does this new America stop choosing money over lives?