My sister’s need for medical insurance makes life interesting

In a recent post, I noted that Lily had been hospitalized for the second time this year. She was discharged after a couple of days, thankfully, and was quickly on the mend. Just in the few days over which she was given antibiotics, I could hear a dramatic improvement in her health: she went from barely able to form words to miserable and whiny to distracted but happy. So it seems that the doctors’ administration of antibiotics was a good thing, although it worries me that I have no idea whether it was actually pneumonia or some other infection. (This may not matter so much to most of us, but Lily nearly died from a Salmonella infection a few years ago, and because her care is handled by many people, well, it’s important to try to understand how and why she gets sick.) (Note: I drafted this post before it turned out that she ended up contracting MRSA during this time period. I’m still not sure whether she became infected while she was on the antibiotics in the hospital, or if it was the initial infection; it may be something we never determine. I am simply thankful that she is recovering now.)

The “adding insult to injury” development in this story (…literally?) is that apparently my parents received written notification that the insurance company decided that this hospitalization was not medically necessary, which I understand means that they are unwilling to disburse funds to cover the stay. My suspicion is that Lily’s case got flagged by someone as causing too much expense, since this was her second hospitalization this calendar year. When my mother was explaining this to me on the phone, the emotion in her voice…well, she was extremely upset. She wondered how it was possible that they decided this, given that Lily was not only frighteningly lethargic, but also having difficulty breathing. (I asked whether the family could solicit a letter of support from the doctors, and she said that she had already written a response to the insurance company that she was going to send to the doctors and to her lawyer.)

When I listened to arguments about how to reform the American health care system (link goes to video/transcript) on Bill Moyers Journal, some time ago, this is the kind of pain I fantasized would be reduced or minimized. It makes me very, very sad and angry to think that my mother pays a huge fraction of her annual salary to maintain a high level of healthcare for the family, and that plan fails to cover an emergency-room based hospital admission and stay. Lily doesn’t get a lot of infections, and except for this year and that one Salmonella incident, she hasn’t been in the hospital for…what, a decade? Which isn’t bad for a blind woman with barely-controlled epilepsy, some dental issues, and some chronic skin problems. And it’s a little infuriating to think that my mother will likely triumph in getting the costs covered…after the insurance company uses up valuable time and money in resisting. It seems shockingly wasteful, if the real point of medical insurance is to give back the money that my family has paid in when something has gone wrong.

…hence my cynicism about healthcare in this country being, above all else, a vehicle to deliver profits. Which makes me that much more grateful to the numerous nurses and the somewhat less plentiful doctors I’ve known or encountered in the course of my sister’s life – people who have given really impressive amounts of love, attention, support, and dedication to their patients.


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