Pre-existing Multiple Sclerosis and Insurance Making Policy & Medical Decisions

Mandy Crest Health Guide
  • I am not uninsured; I am not poor. I am a taxpayer. I’ve never asked for handout and I do not intend to do so now. I do not have access to group health insurance, and since the diagnosis of multiple sclerosis a few years ago, I have a pre-exiting condition.
    I'm concerned about the lack of control regarding my own health care, and see a very real danger of joining the ranks of the uninsured within the next several years if health care reform is not implemented soon.

    When this topic is raised, it invariably leads to protests of, “I don’t want anyone coming between me and my doctor.” Lucky folks. I already have someone between me and my doctor.

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    My doctor and my insurance company make decisions about my health care with little or no input from me. Together, they decide which tests are “necessary,” and where and when I will have them.

    Paperwork moves between the doctor’s staff and the insurance company, winding its way through the red tape until I am informed what amount to pay. It is rare to see an itemized bill, even after surgery. I cannot comparison shop.

    Last year, I waited months to see an orthopedic surgeon to treat my painful frozen shoulder. He spent a couple of minutes with me and told me I would need an MRI. Then he abruptly left the room. When someone from the office staff came in, I was told to go home and wait for a letter. Long story short -- it’s policy. The insurance company must be contacted for permission for the MRI. No discussion. No opportunity for questions or alternatives. I was not part of the equation.

    Another time I had an MRI of the brain. Months later, I still could not get the results, yet my insurance company paid their portion. They weren’t particularly concerned that I didn't get what they paid for. It was only after I refused to pay my portion of the bill that I managed to get the results -- by mail -- along with the “past due” bill.
    Not long ago, things were not this complicated. Doctors spoke directly to me and considered me a partner in my own health care. I paid by check or waited for a bill. Then I submitted my receipt to the insurance company to be reimbursed the appropriate amount according to my policy. I had a relationship with my doctor and a separate relationship with my insurance company.
    When I had young children, I routinely took them to the pediatrician’s office where this system continued to work. All health care decisions were made between the doctor and me.
    Somewhere along the line we lost control. Now the doctor and the insurance company make medical decisions, settle on fees, and even set appointments without patient input. My insurance company, at least as long as I still have one, stands between me and my doctor. I am always left with unanswered questions.

    This system discourages a healthy doctor-patient relationship, one where options are discussed, and questions are asked and answered. We need to give patients more responsibility for their own healthcare decisions, and we need to let doctors get back to patient care.

  • Next Up -- Health Care Reform Part Two: Lack of Options

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    (Pre-existing Conditions, Access to Health Insurance, Deductibles, Tier 4 Drugs)

Published On: October 15, 2008