I found an all-new reason to hate health insurance companies

Last week I went to an eye exam to determine if I am a candidate for lasik surgery. It turns out I am not. Something about the shape of my eyes. It's a condition that is unlikely to affect my vision much, but makes lasik a bad idea and the dr. who did the exam is doing a study on it. I was asked to participate.

Partcipation involves getting some measurements and making a sort of topographical map of my eyes, something that happens during my regular eye exams anyway. It has ZERO affect on my health.

The lady told me she had to check with my insurance company first to see if they would allow it. She has had to unenroll people from the study because their insurance forbid it. They can even refuse to cover you for unrelated things if you do a study they do not approve.

I can understand if the study involves taking medication (especially experimental) or anything that would seriously affect one's health, but this was basically taking a photograph.

The insurance companies are in control... and so out of control.

The lady seemed relieved. The condition is not that common and I get the impression they are having trouble getting enough participants and then insurance companies refuse to allow some people to participate.

I realize that this view goes over like a fart in church on this thread, but my logic is that if the study involves MEDICATION or a procedure (not simply measurements, as in your case), those things have the potential to negatively affect your health.

An insurance company covers you for things that happen to you in the course of normal events, not the things that happen to you as a consequence of ingesting experimental medications. Some meds can screw you up--I was in a trial for a new med some years back and they pulled the study because it was fucking people up (high blood pressure, among other problems).

I would wonder if the purpose of insurance companies' vetting participation is to rule out any ingestion of potentially harmful meds...?

this study involves no medication or anything that affects anyone AT ALL. And still some insurance companies are forbidding it.

Everyone wants medical investigation to cure everything we have, and someone has to participate in these studies.

Maybe some are stupid and just say "NO" to every trial, while others use judgment and determine if there's a drug, a risk, and a potential benefit.

For example, if you're terminally ill and there's a drug that "might" cure you, what's to lose?

The fact that your company said "yes" suggests that they are at least thinking.

A young man had his eye struck by a bungee cord (the kind that lashes items down in a truck bed) and the insurance covered the exam for the injury.

However, his eye was getting fuzzy and he went back for another exam, several months later. It was determined he had blown a hole in the back of his eyeball, which would need to be operated on to keep it from progressing. Before the surgery, the eye had already developed a cyst at the hole, which would also have to be removed. Long story short, the insurance company refused to cover the surgery/hospital charges as it was "elective surgery"!

Why even make the payments for non-coverage? Cruel companies.

Was he able to get the surgery anyway?

was still saying it was elective.

He has been fighting and is going to continue to fight it, but you shouldn't have to go thru that stress in the first place.

he can/could totally get that paid on appeal.

As a clinic manager I see multiple denials happen often and for the flimsiest reasons. These are more likely if you have bad credit, less education, or are poor.

Personally I am still appealing a series of denials ( I am now appealing with a lawyer which means even if I win Iose because 40% of any settlement goes tongue lawyer and i still won't be able afford that surgery ) for a medically necessary spinal surgery that leaves me in constant pain.

I fucking hate insurance company and every whore who works for them. Every last one of the fuckers. This opinion came about because after I had to help council a 30'year old patient with 3 young children that she was likely going to die because the insurance company had denied necessary diagnostic tests for 9 months and then treatment for another 6 months. She died of painful, scream in the night cancer 3 months after that conversation. I fucking hate insurance companies.

This one just hit menhard because we had helped with her infertility and delivery and knew the family personally.

So for me it's hate and rage and disgust. I would personally drive the bulldozer that pushed the insurance companies and all of their risk analysis teams into an open grave. And then dance a jig on the mound.

And I'm still seeing this shit all the time. Ask any of the other doctors or nurses about their stories of woe and disgust.

Thanks for the info.

I guess it all makes sense in "Insurance World", but it sure as hell is a stupid policy to the rest of us.

Seriously, what do they care? Infuriating.

At first it was still seen as too new--the long term results were "unproven" in spite of the widespread use of the technique in other countries for quite some time. Then the insurance companies claimed lasik was an optional thing--like plastic surgery. If you stop to look at the monopoly on eyeglasses, and the huge mark-up that optical shops make on EVERY pair of eyeglasses, keeping lasik an elective procedure--something outside the reach of most folks--seems to be more of a financial decision than anything else.

Similarly, the first line of management for Glaucoma treatment in this country is eye drops. Seems a reasonable approach until you get into it and find out that over time, your system develops a tolerance to an eye drop and you need to switch to another one--usually more expensive--and sometimes not realized until there is a deterioration of your optic nerve/sight. The European standard of treatment is a surgery that frequently requires minimal drugs to maintain once recovery is complete. I am not gonna go into the whole discussion of Marijuana and how it can help treat Glaucoma, but the profit motive sure seems clear with the issue of drops--sometimes multiple ones--on a regular basis.

With my rather jaded view of insurance and treatment guidelines, it should be pretty easy to see how I look at a study that might expand access to lasik for more patients, and I view the insurance companies' decision not to enable participation in that study as being pretty much driven by profit more than anything else.




Laura

All the kids in my family do--they have a half dozen pairs or more for the cost of one overpriced pair here in the USA.

It's fine and dandy to "buy American" but when the damn frames are from overseas anyway, may as well cut out the middleman and buy the cheap ones--better than not being able to afford any. You can get 'em over the internet.

Once I researched that option I never set foot in a US optical shop again. You get absolutely ripped when you buy glasses locally.



Laura

I'm nearsighted and now in bifocals, so I have worn them since I was a little kid. I can see much better in contacts but don't wear them very often. This is because I have to read the &^%$# microprint on bottles and labels, so it's easier to whip off the glasses and read at my 4 inch focal length.

Two good places I have ordered glasses from:

www.goggles4u.com

www.zennioptical.com

When you get a copy of your scrip, be SURE and get your PD Pupillary Distance. they have to give it to you as part of your prescription.

it was not covered by insurance(medicare?). she has 20/20 now.

had their surgeries covered. It doesn't cover your new glasses, if you need a slight correction after you heal, but they pay for the exams, surgery and eyedrops/other supplies.

They don't cover the upgraded lenses, such as Crystalense.

... their goal is not to provide health care when someone needs it , their sole goal is to make money.

I am, however, wondering if the woman you spoke to was in error. From what I have understood from your description (granting my understanding could be in error, which is why I am asking) the study involves monitoring and recording the results of your corneal topographies ... ? nothing more, simply a study mining ddata related to a particular condition ... ?

I am interested because my youngest child has an "unusual" (not rare) degenerative eye disease for which the data from his frquent topographies is mined by many groups studying cornea disease and specifically keratoconus.

The surgery and treatments we have taken him for in Canada have the potential to preclude him from coverage ... but, not sharing the data ... ?

I guess I have more than a passing interest in this.

Check your PM.

but I feel a huge weight off my shoulders living in a country with socialized health care. I wish the USA would get serious about fixing our health care sysyem.

For the 1%.

that when you are a study subject, the study pays the bill.

The insurance paid no bill for this visit.

Really. Unless they're involved in payments they should keep their noses out of your life.

With interest. Then they blame you for getting wet.