appealing a claim

isn't it nice when you appeal a health insurance claim denial, mail in all the info *with* the explanation of benefits and they SOMEHOW re-process the *wrong* claim

i included a document *from you* that included the plan details, the claim id, the dates and providers of service, AND why the claim was denied, and yet somehow you didn't realize that was the claim I appealed

Originally tweeted by Maybe: Leo Ji (@theleoji) on March 8, 2021.

About this $1,800 drug

A claim for pharmacy services through Aetna reduced the drug's cost from $1,752.03 to $30.

I would not have been able to afford this life-saving drug without health insurance.

This $1752.03 drug is Truvada, the brand-name antiviral medication manufactured by Gilead for pre-exposure prophylaxis, or PrEP. The FDA-approved medication greatly reduces the chances of getting HIV — by as much as 90 percent, according to the U.S. Centers for Disease Control and Prevention.

On November 20, 2018, the U.S. Preventative Services Task Force, an independent panel of national experts on preventative medicine, recommended all people at high risk of HIV infection should be offered PrEP.

But it’s not easy. Gilead points out it has financial assistance programs to help patients, but it’s still an incredibly high sticker price. Sure, very few people might pay it all when health insurance foots the bill, and Gilead has programs to try to catch the rest.

What about the people who can’t afford their deductibles, co-pays, or co-insurance? What about the uninsured patients Gilead misses?

What of the reality that “new HIV diagnoses are disproportionately concentrated among injection drug users and black and Latino men who have sex with other men”?

I recognise how fortunate — and how privileged — I am to be on such excellent commerical insurance that Aetna is responsible for about 98 percent of the drug’s cost, and I can use Gilead’s co-pay coupon card to cover the rest. (Yes, this means I get this expensive drug for free.)

But every morning when I swallow one of these pills, I think about the possibility  there are people out there who can’t afford this drug that helps prevent against one of the worst epidemics to hit the LGBTQ community — my brothers, my sisters, my family.

Bless us all.

Here are the Republicans, politicizing human decency

Apparently, we’re okay with 22 million people finding it harder to get medical treatment

Photo by Daan Stevens on Unsplash

The nonpartisan Congressional Budget Office released its report on H.R. 1628, “Better Care Reconciliation Act of 2017” — the Senate Republicans’ answer to abolishing Obamacare.

Multiple news outlets have covered the story, but perhaps the most telling piece of information is this sentence in the CBO’s summary:

“The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation.”

There are over 300 million people in the United States. If the Republican Party is serious about the goals of this legislation, it means they want to leave 1 in 13 Americans out of health insurance, and eliminate or reduce healthcare cost assistance for everyone else.

Story after story has been published on the experiences of Americans saved from bankruptcy because of their health insurance.

I have heard of people whose homes were lost and lives were destroyed because of health care costs due to an unexpected illness; I have not heard, yet, of anyone fiscally ruined by the mandate to purchase health insurance under the Affordable Care Act, and the tax credits offered by the federal government to help pay for it.

Why, then, are Republicans so keen on repealing the Affordance Care Act, with such dire predictions?

If it’s because the individual mandate infringes on individual freedoms, then Republicans seem pretty happy to control when and how a woman can get an abortion.

If it’s because Medicaid and medical costs have been rising rapidly, then this note from the CBO’s summary is telling:

The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers.

So, Republicans will reduce the deficit due to health care costs by repealing a revenue-raising tax on investment income.

If that doesn’t make sense to you, you’re not alone.

The Senate Republicans’ legislation does nothing for the people who need healthcare most. It simply gives yet another tax cut to the country’s richest and wealthiest few, while taking away desperately-needed assistance from the poorest and neediest people in American society.

Republicans seem determined to turn healthcare into an expensive market good, as if receiving life-saving medical treatment at a Massachusetts hospital is the same thing as purchasing a luxury yacht off the shores of Florida.

Unlike other nations (the United Kingdom; Sweden; Switzerland; Canada; France; Taiwan; Japan; China; Singapore; Australia; New Zealand, just to name a few), the United States does not have a universal healthcare or national health insurance scheme, where financial cost is not a barrier to access for medical treatment. The Senate Republicans’ bill will simply make it even harder for Americans to get the medical services they need.

Does the U.S. healthcare system need reform? Yes. But leaving 22 million people without health insurance, raising costs for individuals and families, and giving a tax cut to the rich is not the right way to do it.

The United States is one of the richest countries on the world, and yet basic healthcare and medical treatment for everyone — regardless of your ability to pay — is somehow politically controversial. And I thought it was human decency to heal the sick.