Freelance journalist Edgar Allen Beem lives in Brunswick. The Universal Notebook is his personal, weekly look at the world around him.
My recent health crisis has left me feeling very ambivalent about health insurance. On the one hand, I could never have afforded the hundreds of thousands of dollars my insurance company paid out for my care. On the other, when my health care hit a snag it was usually because of the insurance company.
I feel a little guilty badmouthing Aetna after all the medical bills it paid for me, but then that’s how insurance works. We all share the risk. And it’s not as though Aetna is struggling financially.
Aetna was sold last year to CVS Health for $69 billion and had something like $2 billion in annual profits. The company’s top executives earn tens of millions a year in compensation. Heck, even the board of directors makes a bundle. Former Sen. Olympia Snowe, an Aetna board member, gets paid $276,000 a year just to attend board meetings.
To be perfectly honest, in most cases Aetna’s service has been just fine. The problems arose when health care providers seemed more interested in serving the insurance company than providing care.
The worst-case scenario took place when a young doctor on my “team” informed me that there was no longer any medical reason for me to be in the hospital, so I would be discharged the next day. I told her I wasn’t sure I was ready. When I told my gastroenterologist what she had said, he replied, “You mean other than that you have severe pancreatitis, you’ve lost 50 pounds and you just started a new medication?”
When I objected to being discharged against my will, the young doctor brought a case manager to my bedside and they informed me that if I insisted on staying, I would have to pay out of pocket. I concluded the doctor cared more about pleasing the health insurance company than treating the patient.
I went home for one night. An ambulance brought me back the following day with a massive internal hemorrhage. I then spent six days unconscious in the intensive care unit. I tried to tell her I wasn’t ready to go home.
Health care workers seem to be afraid of insurance companies for some reason. When I finally went home I had a prescription for a fentanyl patch. My local pharmacy said they couldn’t fill it without prior authorization from Aetna, which turned down the claim, arguing that I didn’t need fentanyl because I didn’t have cancer and wasn’t terminal. My primary care physician, gastroenterologist and surgeon (who had cut me open from sternum to umbilical to stop the bleeding) all thought I needed fentanyl, but Aetna didn’t. I finally persuaded the drug store to let me pay for the Rx myself.
Then there was the case of the $600 pill. I had completed six days of a seven-day course of antibiotics when I was finally discharged in September. When we went to the pharmacy to pick up the final dose, we were told it would cost $600. I didn’t buy it.
According to recent Kaiser Family Foundation polls, the majority of Americans agree on the health care reforms we need in this country. We need the government to negotiate prescription drug prices (85%). We need protection against “surprise” medical bills from out of network providers when we are hospitalized (78%). And we need either Medicare for all (53%) or a public option insurance plan (69%). What we do not need are doctors allowing insurance companies to tell them how to practice medicine.
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