Tik-Toker With Endometriosis Tries Getting Insurance To Cover Prescription Meds

Kristen Mae
·6 min read

$5,349.53.

That is the cost of a single prescription for one patient’s endometriosis medicine. Watch this video and tell me it doesn’t make you want to go scorched earth on the health insurance and pharmaceutical industries.

Five. Thousand. Dollars. This makes me want to scream forever and ever. Insurance or no insurance, no medicine should cost this much. Ever. This is not normal.

The TikTok user from the clip shown above posted several follow-up videos of themself on the phone with their doctor’s office, their insurance, the pharmacy — what I call the healthcare industry’s “triangle of hell.” Each time they call, they’re given the run-around in a way that makes it painfully obvious that the insurance company is making it as hard as possible for them to get their meds covered.

A simple change of insurance is what led to this situation where a person living with endometriosis, a disorder in which uterine tissue grows outside of the uterus and can cause intense pain, had to spend hours and hours on the phone going back and forth simply trying to obtain the medicine that their fucking doctor prescribed.

The medical provider is saying “My patient needs this,” and the insurance company — which literally profits every time they deny coverage — is saying “lol no, sorry.” And this is all perfectly legal. Normal, even. This is our healthcare system, ha ha, what a hassle, amiright?

How is this reality?

Why are we not rioting in the streets over this? How in the actual fuck have we normalized a system in which massive corporations profit off of people getting and staying sick? How is it legal for companies to exist for the sole and express purpose of profiting off of people’s sickness? How is it acceptable for companies to profit more when they deny coverage for treatment?

Kiyoshi Hijiki/Getty
Kiyoshi Hijiki/Getty

Insurance companies by their very nature have a massive conflict of interest. Their stated purpose is to provide coverage for healthcare, yet they profit more when they deny that coverage. That runaround you get when you have a problem with your insurance — when they’ve made a mistake or need prior authorization or *fill in the blank for the reason they can’t cover you*? That is deliberate. That system is set up that way by design.

Same with pharmaceutical companies. A cure for diabetes would cause a huge segment of the pharmaceutical industry to collapse. They literally have a financial incentive to keep people sick and in need of constant treatment.

Chronically ill people are the biggest sources of revenue for pharmaceutical companies, and health insurance companies make the most profit when they deny care or dictate the kind and amount of care provided.

NONE OF THIS IS NORMAL OR OKAY, AND WE ARE NOT ANGRY ENOUGH.

We should be enraged that our healthcare system has commodified people’s health. We should be furious that our sickness is literally for sale. We are not the greatest country in the world. This system where people can go bankrupt because they were unlucky enough to get sick is beyond shameful. It’s unforgivable.

In 2019, my partner had top surgery, which their insurance company told them was covered under their plan. They paid the doctor out of pocket in advance, having been told by their insurance company that they’d be reimbursed a portion of that later, upon filing a claim. But the surgeon billed the insurance company not the amount he charged my partner, but about eight times more. So the amount that my partner should have gotten back from the insurance company as reimbursement for what they paid the surgeon was instead forwarded to the surgeon for an amount he claimed he billed my partner but didn’t. To top it off, the insurance company made sure to let my partner know that they would be responsible for the remaining ~$60,000 should the doctor decide to pursue payment of that “bill.” A bill that never existed.

Doctors overbilling insurance providers is common practice. Insurance companies set arbitrary limits for how much they’ll reimburse for any given service or treatment. Because of this, doctors purposefully bill an amount far over what they suppose that limit might be in order to ensure they get paid the maximum benefit allowed.

Pharmaceutical companies are as bad as insurance companies, if not worse. California rep Katie Porter went viral on Twitter for roasting former Celgene CEO Mark Alles for price gouging for his own personal enrichment. He inflated the price of his company’s cancer drug, Revlimid, so the company could hit annual earnings targets and he could collect his half-million dollar bonus. Cancer patients were burning through their savings trying to get their life-prolonging medicine while Alles earned a single-year salary of $13 million. These are the loathsome scumbags controlling Americans’ healthcare.

Capitalism can work for some things — it can spur competition and innovation. But capitalism should not apply to healthcare. It should not be acceptable to commodify a person’s health. Nobody should profit huge amounts of money off of making people well or keeping them sick. Sure, earn a living from it. Make it worthwhile to work in that profession. Fine. But $13 fucking million? No. Fuck that.

Watch that TikTok video again. Watch this young person’s face fall as the woman on the phone tells them how much their medicine is going to cost because their insurance company decided — tra-la-la and fuck you, peasant — that they’re not going to cover it.

We don’t need a cute little adjustment of the Affordable Care Act so that Americans can have “access” to “affordable, quality health care.” I have a policy under the ACA and it’s expensive as fuck and shitty coverage. We need universal healthcare. Nobody should be bursting into tears while the people they’ve paid to care for them tell them over the phone that the treatment their doctor said they needed isn’t going to be covered. Nobody should have to tangle themselves in the phone call web of doom between their healthcare provider, insurance company, and pharmacy for days on end while they live with pain.

Americans need to be way more mad about this than we are. We need to be calling our representatives and demanding universal healthcare. We need to demand that our political leaders figure this out. At the very least, every American should have the same coverage that the political leaders who work for them enjoy.

Call now. Act now. Don’t wait until you get sick and it’s you crying on the phone while the insurance company you’ve been paying into tells you it has decided not to cover the care you need to stay alive.

See the original article on ScaryMommy.com