colorado springs, colo. -- barbara calder lives in nearly constant pain. her limbs dislocate at the slightest movement, even when she turns over in bed at night. she wears her hair short because brushing it hurts too much.
mrs. calder suffers from ehlers-danlos syndrome, a rare genetic disorder in which the connective tissue that binds the body together gradually falls apart. but, although she began suspecting she had the disease 16 months ago and had health insurance, she spent a year battling numerous roadblocks just to see a specialist who could diagnose her condition
. now mrs. calder says she is left wondering whether she's going to die suddenly because she can't get the test that would tell her whether she has the fatal form of the disease.
mrs. calder's difficulties mirror those of millions of insured americans who get lost in the u.s. health-care system's giant maze
. for many, the journey is frustrated by coverage limits, denied claims and impersonal service.
Nov 21, '07
the article clearly cites how she is uninsured and her health insurance refuses to pay for pain relief and diagnostic testing:
she still doesn't know whether she has the vascular type of eds. she worries that if she does, then her daughter and her eldest son, who is 21 and also has joint problems, probably have it, too, putting them at risk of dying young. even though both have health insurance through their jobs as hotel employees, neither has sought a firm diagnosis from a geneticist. they fear that having a pre-existing condition on their medical record would make it hard to get individual insurance policies if they are laid off.
in recent weeks, mrs. calder has been lobbying mr. calder and her children to move to belgium, where she once lived with her ex-husband, arguing that they could get good care there cheaply through the country's universal health-care system. one of the leading researchers of eds is a belgian geneticist who works at the university of ghent.
no platitudes just real people who are having difficulty accessing health care.
Last edit by HM2VikingRN on Nov 22, '07
Nov 22, '07
Quote from crna2007
if she is uninsured than how can her health insurance refuse to pay for pain relief and diagnostic testing? for every one person you can show who has this so called maze of health care hoops to jump through there are thousands who get great treatment from their health insurance plans.
an anthem spokesman, james kappel, says it considers celebrex a "step-therapy" drug and doesn't cover it unless other, cheaper treatments have been tried first.
mrs. calder says she called anthem back a week later to inquire whether her policy covered genetic tests. and once again she was stymied by a misunderstanding.
mrs. calder says a representative told her that anthem doesn't usually cover tests for diseases that aren't treatable. mr. kappel says anthem has no record of that call and that skin biopsies were in fact covered by mrs. calder's plan. "if we had received a call about a skin biopsy, we would have approved it," he says.
these are classic examples of how benefit denial specialists interfere with appropriate patient care.
is national health insurance “socialized medicine”?
no. socialized medicine is a system in which doctors and hospitals work for the government and draw salaries from the government. doctors in the veterans administration and the armed services are paid this way. examples also exist in great britain and spain. but in most european countries, canada, australia and japan they have socialized financing
, or socialized health insurance
, not socialized medicine
. the government pays for care that is delivered in the private (mostly not-for-profit) sector. this is similar to how medicare works in this country. doctors are in private practice and are paid on a fee-for-service basis from government funds. the government does not own or manage their medical practices or hospitals.
the term socialized medicine is often used to conjure images of government bureaucratic interference in medical care. that does not describe what happens in countries with national health insurance. it does describe the interference by insurance company bureaucrats in our health system.
Last edit by HM2VikingRN on Nov 22, '07