Monday, November 23, 2015


I'm still in insurance hell and I am placing this squarely on the shoulders of the health insurance companies. They are getting away with things, just because they can. Until they can't and if I have anything to say about it, they are going to have to answer for some of the nonsense that is going on at the moment.

My understanding at this point is this. The insurance companies have greatly diminished their networks for individuals and in most cases, small businesses. So, to answer the question in my prior post, YES, the ACA has allowed insurance companies to increase the disparity in healthcare. They are finding each and every loophole and they are exploiting each and every one of them.

I distinctly remember hearing these words come from the president. "You like your doctor, you can keep your doctor." And, "You like your plan, you can keep your plan." This, apparently, was nothing more than political double-talk. It applied to grandfathered plans (which are for the most part, non-existent) and at this point, I did like my plan, it got replaced by a horrible one. I found a new plan and I liked that, too. That's no longer an option, either. Remember that thing about the three biggest lies. I'll stick with the only one that's not raunchy. "The check is in the mail." And, I'll say this. That lie has been blown (for my raunchy friends, yes, find the pun) to bits by this *keep your doctor/keep your plan* lie.

Where do I stand? I hate my options because I have none. I'm being dictated to and even if I wanted to pay a ton of money, NO plan meets my needs. I do not want a gatekeeper. Must I seriously go back to the days of getting a referral to see a specialist? The answer to that question would be a resounding yes if you are part of a small group or on an individual policy. Yes, there are options without the gatekeeper and those policies use some very large and decent networks. However, in the case of the individuals or small businesses, they've butchered the network allowing for extremely limited choices.

Then, we have the medication issue. Two of my medications require prior authorization. It's likely neither will be authorized because there are generic versions. I have nothing against generics except when they don't work and in some people, some generics simply don't work. I had the misfortune of learning that first hand. On my "no gatekeeper" option policy, neither one of my medications is even on their list. Period. End of story. Not even for prior authorization. It's the generic or nothing.

This is wrong on every level. I have checked each policy available to small groups and to individuals. I am only looking at non-subsidized policies ("off exchange").  One by one, they are tossed into the unacceptable pile. I can't begin to imagine the frustration of those who are seeking exchange policies because the subsidy is essential. I wonder how horrific those networks are or what those drug formularies look like.

Enough ranting here. It's time to join forces and involve the officials in NYS who have the ability to do something. I will be doing that.

The only good thing to share today? Trial Reach and Cure Click are joining forces. I'm a big fan of each. You will notice the widget in the upper right column. It happens to be for diabetes trials but as a fan of all research and a bigger fan of clinical trials, the quickest way to accrue clinical trials is by making sure everyone who is eligible to participate is aware the trial exists. Yes, I'm an ambassador for Cure Click. In fact, I am on their advisory board. And yes, I was paid by Trial Reach to assist in a project a few months back. It would be disingenuous for me to fail to share that information but I've said it before and I'll say it again, nothing on this blog is here unless I believe in what they are doing.

I believe in Cure Click and Trial Reach and if you happen to know someone with diabetes, have them take that for a test ride. Will I be compensated? Yes. I'm not even certain what the compensation is. I didn't read that far but I promise this, should I receive any compensation because someone clicked the diabetes button and found a trial, I will take the entire amount and donate it to a diabetes charity. Sometimes it's about the money and other times, like now, it's about seeing how a platform works and if it is an effective means of advancing the research. For me, this is all about the latter.

And now, back to my Albany issues......

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