Health Insurance Coverage Protects from Catastrophic Health Costs (!?!)

Lisa Emrich Living With It Musician, Patient Advocate, and Founder - Carnival of MS Bloggers Lisa Emrich is a professional musician. She happens to live with... Send Message Subscribe: Lisa Emrich

Tuesday, September 02, 2008
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So someone asks me, “What’s the hardest part of living with multiple sclerosis, Lisa?” I would have to answer INSURANCE!!! “Really? Not the blindness, not the numbness or persistent tingling, not even the weakness or lack of coordination, ...

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Untitled Comment
rwboughton
Tuesday, September 02, 2008 at 01:17 PM

Yeah, insurance is certainly near the top of the list. Aside from costing every year more than we have, there is the stress caused by the quandary. What gets me is that even though I am fully insured through my workplace (a hospital to boot), the Avonex and the MRIs and all the rest ends up costing me an arm and a leg. It's almost like "What's the point in all that money coming out of my paycheck. I thought it was for insurance to pay for such things." We are surely at the mercy of these insurance companies, and something really, really needs to change.

re: Untitled Comment
Lisa Emrich
Tuesday, September 02, 2008 at 01:35 PM

The increasing cost of premiums, increasing cost-sharing formulas, and decreasing value of benefits are all contributing to a brewing discontent, even with folks who previously were unaware that there was a problem.

In the course of 8 years my premiums have more than doubled.

In 2002-2004 it was a 44% increase. In 2006-2008 it was a 38% increase. This far exceeds the national averages of increases seen in the group health insurance market.

To top it off, McCain want MORE people to jump to the individual market. I want to say - "NO!!! Go back, go back!! There are far too many problems here."

But I'm just one voice. We need many more to speak up. Thank you for sharing.

I hear ya...
Mandy Crest
Tuesday, September 02, 2008 at 03:09 PM

Lisa,

You're singing my song. Since you're a musician, are you interested in starting a choir? Perhaps we could sing on the steps of the capitol building.

And a one... and a two...

"Will MS Break Your Family Budget?"

re: I hear ya...
Lisa Emrich
Tuesday, September 02, 2008 at 04:03 PM

"The Hill is alive with the sound of MonSters,

With Bills they have pushed for us to protect.

The Hill fills my heart with the song reform,

My voice wants to sing very loud and clear."

What insurance?
Susan Cagley
Tuesday, September 02, 2008 at 03:45 PM

Saturday I got a letter in the mail form DHS. In this woulderful letter I though that I would still have my insurance, not so. Last week I had a meeting to review my case. They told me in the office that I would not lose my insurance and that I could even get food stamps. I didn't need food stamps I decined it. When the letter came they said I couldn't even got my medicare anymore. I lost my Tenn care even. They could even let me have food stamps even though I didn't ask for them. I don't know what to do now but I am not giving up. Even if I have to appeal this I'm going to try. It can hurt. I even lost my alimony because the child support has stopped. I am going to live lol and I will find a way. Even leagal aid can't help, but God can and He will.

re: What insurance?
Lisa Emrich
Tuesday, September 02, 2008 at 04:08 PM

Wow Susan,

What a disappointing letter to receive. I do hope that you following through with the appeal. That's alot of things to lose out on in one fail swoop. I don't know that rules in Tennessee, but certainly call your local NMSS chapter and see if they have someone who specializes in these services to assist you with your case.

Hang in there, ok?

Lisa

Excellent article!
Merely Me
Tuesday, September 02, 2008 at 07:50 PM

This is one of your best articles Lisa...full of information and you are telling it like it is!

Politics will be very important this election year. Which candidate has our best interests at heart as far as health care reform? Maybe some folk aren't worried about health care but I can honestly say that now...health care and the economy are at the top of my list of concerns.

My neurologist is talking about me trying one of the oral drugs, fingolimod,(hope I spelled that right) when it comes out and is approved. Do you have any idea if insurance will be more likely to cover such a drug?

Keep putting this sort of information out there....I am sure so many will benefit from it.

re: Excellent article!
Lisa Emrich
Wednesday, September 03, 2008 at 09:01 AM

Good morning Merely,

Thank you for the kudos. I'm blushing now.

Here's my thought on any of the oral meds which may be approved in the future.

First, they will not be self-injectables so that's a great bonus and takes them off of the Tier 4 of most plans and they would not require the use of a specialty pharmacy (I'm guessing cause I've not looked specifically into Fingolimod).

Second, I'm hoping that they will cost much less than the injectables which would be wise if the drug company want to grab a huge portion of the market share. So insurance would be even more willing to cover them.

(However with Acorda planning to charge up to $10,000 for their new drug, the oral DMDs might not be THAT much cheaper than the injectables.)

Also, in preparation for launch, the drug company will work tirelessly to negotiate coverage on the formularies with insurance companies. It's in their interest to make sure that the drug will be utilized.

However, all of this is moot if you have the type of drug benefits I do where formulary matters much less than cost.

I'll try to closer look into the potential oral DMDs and get a better idea of what they're all about.

Thanks for stopping by.

Individual insurance
Jen
Wednesday, September 03, 2008 at 12:41 AM

Thanks for writing about individual health insurance, Lisa. A lot of people are covered with group insurance or Medicare or Medicaid, so maybe not so many people are aware of its pitfalls. I wasn't. I'm glad there are Rx assistance programs, but they sound a bit thorny as well. There is a problem when people pay good money for insurance, but still need to shell out more money to cover expensive prescriptions (that should be covered.) Regardless of the type of coverage, this seems to be the norm.

Good night---

Jen

re: Individual insurance
Lisa Emrich
Wednesday, September 03, 2008 at 09:04 AM

Hi Jen,

I agree that more needs to be said about individual vs. group health insurance plans. The same is true regarding Rx assistance programs.

We are thinking on the same wave length, because those are two of the next topics I'm preparing to discuss in greater detail.

So mum's the word so that we don't give away the surprise.

Untitled Comment
sue
Wednesday, September 03, 2008 at 02:18 PM

Hi Lisa. I think you are right. Even with out MS, one of the most stressful things is lackof financial security. I have been know to roam the house with worry on this one. Maybe we'll be in a different place over the next few years if the election goes the way the Democrats would like it to. Who knows politics is tricky business. Kinda like MS.

Anyway, you can find out more information on insurance through our Care Central site and even by contacting some of the national organizations aiding sufferers of Multiple Sclerosis.

Hope this helps and all the best, sue