In June Owen survived a potentially life-threatening medical
event. Due to his rare complex medical needs his body was unable to fight off a
common stomach bug and he nearly died. We are incredibly fortunate that since
that day, Owen hasn't missed a beat. He is back to his silly self and looking
forward to 3rd grade. His resilience is remarkable.As parents, we re-analyze every detail of those critical moments to try and mitigate future crisis… we troubleshoot the situation and try to add mental flags in attempt to make future events less critical, save us all from the pain, stress and handfuls of grey hair. Because we choose let Owen live outside of a bubble- there will always be factors out of our control that could affect his life... but, to some extent- isn't that a risk we all take as parents as we raise our children in the world?
A few weeks ago we got a letter from our primary insurance company letting us know a 'partner in care' would be contacting us soon to help us manage Owen's healthcare needs. My guard and blood pressure instantly shot up. While I don’t like to think of myself as a tin-foil hat conspiracy theorist, I am a skeptic when it comes to the sudden interest shown by our insurance company in my sons’ medical needs and considering the timing of this letter it might have something to do with the abundance of claims submitted as a result of his crisis in June. The letter promises a new nurse ‘partner’ in our healthcare team to help us make more informed healthcare decisions for him…. I have no doubt that the nurse is a good person, but I’m not sure if a person employed by a company with a business model relying on profit from subscribers should be involved in critical medical decisions. Conflict of interest much? The letter is nothing but a thinly veiled introduction to the risk management team, because the money monster insurance company is losing money on Owen’s care. Insurance companies are about making profit and I’m pretty sure the claims submitted following this last crisis have wiped out any hope of profit they will ever make off of our premium payments. The insurance company has moved to ‘loss mitigation’ mode.
All right, everyone…. Grab your partner- join hands. A new song and dance is about to begin. This morning the coordinator finally called to set up the next call with our new ‘partner.’ I did my best to calmly and clearly articulate my skepticism of this new ‘partner’ our son has been assigned. The woman was kind and it was obvious she was not prepared for my questions and didn’t understand my lack of enthusiasm about our new ‘resource’ we were being given. I explained my concern about sharing privileged medical information with a ‘nurse’ employed by our insurance company…. She said that in certain cases they seek diagnostic information and already have a file regarding Owen’s diagnosis, so privileged information really shouldn’t be a concern. Whoa.. In all other medical information sharing experiences I've had to sign specific waivers for doctors/specialists/agencies to communicate about specific medical records. I don’t recall ever giving this kind of consent, but I suppose it is buried somewhere in the policy. I calmly continued to dive into questions about the ‘partner’ and how need was established. She told me that often members call and ask for help navigating chronic medical problems and the nurse could help provide guidance and support. I told her this is not a program we inquired about and I found it puzzling that we have two children with complex medical needs and our first referral to the ‘resource’ only happened weeks after a medical crisis- that medical payouts seemed to be the deciding factor that lead to our involuntary case assignment. She said while most cases are a result of members calling in with questions about complex medical needs coverage, some cases are referred as a result of risk analysis team recommendation. Well, we haven’t called requesting services…. So. Money. A profit and loss team looked at our case and found out what we already know… caring for our child is expensive.
It is beyond frustrating. It’s why I continue to write about our experiences in dealing with insurance companies and the hurdles we face managing the healthcare needs of our family while providing a life for our children. The value of your life is not measured by character, love, or the invaluable price of your existence- your value is in dollars and there is a price on your head, because healthcare in our country is for profit and a for the privileged. It’s why I will continue to support a universal healthcare system that puts providers and patients in the driver seats when making healthcare decisions and take the money mongering insurance companies interests out of the equation. This new ‘partner’ in healthcare that has been offered to our family by our insurance company is nothing but lifeless risk management maneuver with no personal connection or genuine interest in the well-being of our family. Its only purpose is the well-being of their payout portfolio. It’s disgusting. Once again, in the current healthcare system structure, our family has been reminded that Owen’s value as a human has exceeded the dollar value that has been placed on his head. It's sick.
