The patient suffers when insurance plays doctor

It’s 3:45 in the afternoon here.  I had a very relaxing day and A FEW POTS of coffee with a friend today.  We literally sat at the kitchen table and drank coffee for hours.  While the fact that I sat still in one room was probably very relaxing for Danica, ( she didn’t have to follow me room to room as I fidgeted) it just dawned on me an hour ago why I was able to sit still……

SLUMP WEEK has begun 😦

What makes it worse, is knowing that this week it is going to get worse, because I have to wait an extra week plus to get my infusion of Tysabri.  Yah Holiday stress and Slump week combined…oh joy.  For those of you that don’t know what slump week is or haven’t heard the expression before, I have written about it in a previous post here. Defining Slump Week Tysabri.

So why do I have to wait an extra week for a medicine that I am supposed to receive every 28 days? Because …..


For those of us that are considered “Disabled” by the government ( well by doctors and then the government) Medicare controls our lives.  Medicare gets to decide what kind of care you can receive and when.  Makes complete sense doesn’t it?  HELL NO!!!  A group of individuals that are not doctors, and who have not and will not ever meet or see me, get to decide WHEN I can receive treatment for Multiple Sclerosis.  I call bunk, bullshit however you want to describe it.

With the new year coming we all have “deductibles” to meet before any of our medical care is covered.  I get that part, kind of….Maybe for people that do not have a chronic or incurable illness, but for people that rely on medications and treatments just to get up in the morning or be able to function at all it makes no sense.  I have still not actually gotten to my point though.

My last infusion was December 1, 2017.  I schedule my appointments for as close to the first of each month as possible, because in addition to meeting a yearly deductible, I personally have to meet a monthly deductible before Medicaid will consider paying the difference.

The hospital bills Medicare $34,978.93 EACH MONTH for my Tysabri Infusion.

Yes that is almost 35,000$ a month…..NOT A TYPO

After Medicare pays their 80%, or negotiated rate, the copay of $1183.52 is billed to me… Heh what the hell that’s pocket change right?

Not to me!!!!! and not to most  people that are unable to work because of an illness.  Hell I don’t think that is pocket change to anybody….. So anyway, this is where Medicaid comes in.  Each month after I meet my Medicaid spendown of medical bills, which for the record is $380.00 a month, Medicaid will review the claim to pay the difference.  Do you see why I have to have my infusion on the first of the month?  I’m sorry if I haven’t been able to explain it well, it honestly makes no sense to me.

So if I were to go and get my Tysabri Infusion on Friday when I am due for it, I will not be able to get it again until January 19th of next year.  It will take them how many months to process all of the claims while I WAIT to have insurance?!?!?  This does not cover or include any of my prescriptions which average about $2800.00 a month, or physical therapy, etc etc etc.  Basically it sucks.

I know that there are people that have it worse than me.  And I know that slump week will pass, but it is definitely here now.  I will spend the next week as I am now, READY FOR BED at 4 pm in the afternoon (ok its actually 5, but that’s still pretty early). In pain, with worsening symptoms. I don’t allow myself to make important decisions while I am living in a daze from the cognitive fog, so no blogging until next year?  I don’t know.

So I want to take this opportunity to Wish Everyone a Happy Holiday and New Year.  I also apologize in advance if it takes me a bit longer than usual to respond.

Being sick sucks 😦

9 thoughts on “The patient suffers when insurance plays doctor

  1. I don’t want to sound like I don’t know that our US Health system is fucked, but WHOLLY SHIT! 35K ? OMG!!! You poor dear.
    It makes me ill (no pun) to think that other people outside our country thinks we have it so good, and then you have us Americans who have to decide medication or food. Yeah, it’s a wonder why I want to move elsewhere.
    Please take care of yourself, dear. 🙂

    Liked by 2 people

  2. you definitely have it worse than me. I’m on Medicaid and I have to fight for everything but my scripts aren’t anything like yours. I get anemia infusions once a month and I know they’re expensive but I haven’t seen a bill yet. Meanwhile, I can’t work due to chronic illness and my disability was denied by a team of beaurocrats who decided I wasn’t disabled.
    The system is definitely not working but for all it’s worth I do understand your struggle and sincerely hope it gets better for you. Your strength is inspiring

    Liked by 1 person

  3. I know it sucks being sick but you have an amazing strength and will overcome it all!! Take everything slow and do not worry about posts you want to respond to or read, they will still be there in a few days. You need to take care of yourself and make YOU #1. I already think you are pretty great! I am responding and blogging a little slower these days but it gets done. I am sorry I am late responding to you! Much love my dear and I hope you have a wonderful and relaxing holiday!!!!!! Do not push yourself too much, please!!!!

    Liked by 1 person

  4. Yes it does honey. I wish I could say sth to make it better, but I can’t. Even if did, it coudn’t improve the whole mess they did with healthcare in the States. It’s horrible. People save their whole lives and get bankrupt over night when they become ill.
    Happy holidays and chin up.

    Liked by 1 person

  5. Don’t get me going on this topic. You and I have talked about this before. As long as the healthcare and insurance industries remain profit based, this shit is going to continue, and it does not matter whether it is a governmental or a private insurance plan involved.

    Liked by 1 person

  6. Wow, I relate. I have had 5 insurance changes in2017! Have to recertifyfor my prescriptions. And depending on which insurance, my copay varies from 3.00 to 80.00. At one point, I was also told I made too much for subsidyand my insurance wouldn’t pay the 2300 monthly. With Affordable Care and same salary, qualified for a subsidy which broght it down to 30. Had another job where I literally made fifty thousand less (yes, I’ve been blessed) but with corporate insurance qualified for subsidy that brought it to 80 a month and I used flex spending. Waiting for Medicaid to kick in, they told me I could put out the now 4600 a month for the drug and I’d get reimbursed for what Medicaid paid. Uh, I’m on Medicaid for a reason? I truly believe that this government wants people like us to disappear

    Liked by 1 person

    1. It is so sad, but I believe it may be true about them wanting us to disappear… God forbid you say it to someone though and all of a sudden you are a crazy conspiracy theorist… NO I live it every damn day and have the non photo shopped pictures ( medical bills) to prove it


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