Tag: Insurance

I Can See Clearly Now

When I told him he said that was entirely unacceptable. “You can’t wear lenses without a fitting.” The fact that I could see with these and not with the ones that were “fitted” was not the point.

I can see clearly now, but he doesn’t care…

It happened about a year ago. A visit to the eye doctor got me to discover what I’ve been missing. My eyes have always been affected by multiple problems that are not typical for a person my age. I am farsighted. I have astigmatism. I have had to wear glasses since I was in kindergarten. It seemed like I will never see clearly without glasses again.

Still it hasn’t stopped me from trying to wear contact lenses. My first try was in college. I had limited success. Contacts have trouble with astigmatism. Then came the Astigmatic lens also known as Toric. This lens was supposed to conquer astigmatism but it was still of marginal improvement and expensive. As I got older, I developed the “older eye” problem and now I needed bifocals.

Clearly my eyewear was getting more expensive and I believe that in an effort to minimize the cost to me, my optometrist was not showing me the possible solutions. A recent change at my eyecare center has had me seeing a new doctor. This doctor is very confident. When I told him that I was having limited success with contacts…he gave me the option to try a lens made for astigmatism and multifocal. I agreed.

The “fitting” is one of the options for my optical insurance plan. It won’t pay for all of it but it does get some of it. He ordered the lens and a few weeks later it arrived and I went back in to pick them up. The whole process was fouled up when the intake person treated me as a regular checkup person and numbed my eyes. Even with glasses, my world was a blur. I couldn’t put the contacts in my eyes because the feeling wasn’t there. I couldn’t tell whether my vision was improved because my world was a blur. It was at this moment that the doctor went from confident to arrogant as he and the assistant were dismissive of my feelings and my condition as they assured me that this would wear off in a matter of minutes. An hour later, I took my sample lenses and went on my way.

During the week, I had limited success but with my experience with other lenses, I figured that I would get used to it. He ordered the lenses and used up the rest of my insurance. As the week went by, I sought out some other pricing on the lenses on the Internet and found my brand and several others as well. I found a national brand that used to be the one name in contact lenses. I figured that they would be the most expensive. They weren’t. Since he sent me with measurements as well, I plugged in his numbers into the new brand. When they arrived…wow! I can see clearly now!! Also, they went in and out so easily and I could wear them for about 8 to 10 hours a day. The ones that were “fitted” were of no value whatsoever and have never touched my eyes again. (Sometimes, I didn’t know that they were there because they were huge and the edges disappeared and I would be digging at my cornea to access them.)

Fast forward about a year. I got the message from my eye doctor that it was time for my annual eye checkup. (Doctor speak for annual insurance money for the taking.) I hemmed and hawed privately about this…but I certainly wanted to let the doctor know that he was the one who turned me on to this lens technology and were it not for the fitting snafu…I never would have discovered the lenses that I have now.

When I told him he said that was entirely unacceptable. “You can’t wear lenses without a fitting.” The fact that I could see with these and not with the ones that were “fitted” was not the point. When he stated, “I don’t make the rules, I just have to follow them,” I then determined that I fall in 3rd or 4th place when it comes to my health.

Here is my perceived order of priority.

  1. Insurance Company
    • Optical Insurance comes almost exclusively with a group plan. Here, the company gets an enormous amount of money that the consumer doesn’t see so that they can be “placated” by perceived benefits.
  2. Vision Correction Vendor
    • This is the limited amount of vendors allowed to offer products through a particular doctor or group plan. The prices for these items are fixed at a significantly higher rate than what you can find online.
  3. The Optometry Practice
    • Every January, I get the important notification that my vision is important and needs to be monitored. When I get in I am run through a series of tests by persons in blue medical scrubs using machines. Their repetitive practice to these processes is what ultimately led to my “useless fitting” last year as a quick question to the patient as to “why are you here?” would have stopped the problem from happening.
  4. The Patient (Me)

My vision insurance has their own “in house” supplier of eyewear and contact lenses. My brand was not on the list. (It wasn’t on the optometrist list either as I heard him tell his administrator who orders and schedules the fittings that it would not be found on the drop down list.) SHOCKER. This “company store” scenario allows them to take the brand that could be shopped for best price and build in extra cost so there wouldn’t be an insurance loss to them.

Insurance companies should be there to stop you from having a devastating financial event linked to a medical issue. Instead, they charge huge amounts of money and placate us with these “perceived” benefits and then rope in the very institutions that are supposed to be there for the patient but grind all the money that they can from our little placations.

When I had my trouble last year, I decided that my “new patient” experiences would be a me first and it has worked well as I have had several instances where I have had success.

  • 7/1 Ganglion Cyst. Great Podiatrist. We planned the remedy together. Reworked my whole supplementation plan that day.
  • 11/13 Broken Arm. Great Orthopedists. They listened to me and told me to decide if follow up appointments were necessary. (They weren’t)
  • 3/29 Cardiologist for preventative concern. Family history and reading had me concerned about Calcium buildup in my arteries. I sought out a Cardiologist and he ordered a scan that I had read about and is often not covered by insurance…surprise surprise. Amazingly, the test happened yesterday and the results came in as I am typing this. Now we, my doctor and me, can move forward in developing a plan to take care of this before it becomes a problem.
  • 4/12 Optomotrist. Looks like he might have to go.
Health Insurance Makes Me Sick

Stem Cells and Pain

Medical marketing to a population in pain that is largely on a fixed income for the promise of pain relief through intervention that is cost effective comparatively to some other procedures is infuriating.

In February of 2018, I made a permanent move to California from New Jersey. I knew I should establish some local doctors and as luck would have it, my chronic knee pain reached levels of pain that required me to seek immediate medical help. Urgent Care didn’t have the resources to check my leg for the suspected Baker’s Cyst or blood clot, so I went to the emergency room and they were both confirmed. Since I have had blood clots in the past, a surgical option was moved to the bottom of my list and I began to pay attention to the Stem Cell advertisements that came to me by way of Facebook. I attended a free luncheon.

The information that I received in April of 2018 was very informative and I was ready to get the treatment. Financially, I wasn’t. It seems that this therapy although allowed to be performed by doctors, was still not covered by insurance. The cost of Dr. Duffner’s therapy was $6,000 and if I committed to the treatment, I would get a $500 discount. I didn’t have the $5,500 at the time, and they were willing to let me go into debt with something called Care Credit. I didn’t take it because I had enough debt already.

I limped along for another two months and met my new “family doctor” and we ran some tests. The doctor had concerns about my blood work and my family history, but he was happy to keep me on my blood thinners. I asked him to refer me to Dr. Duffner for an orthopedic followup, but I never got a call.

My leg got stronger over the next 11 months but I hadn’t been “pushing it”. I wanted to exercise to lose the weight that I had put on and improve my overall health. In May of 2019, I read the Plant Paradox by Dr. Steven Gundry. I lost 30 pounds, improved my blood numbers, and my pain in my leg all but vanished. Still, I know that I have some lurking issues in the knee. I decided to visit another Stem Cell Seminar. I figured now that it is being more advertised in the mainstream, the competition alone would bring prices more competitive. I was wrong.

Dr. Olesnicky and Dr. Hashimoto are on TV and the Internet and targeting the population of the Coachella Valley. Their costs are $8,900 for the same Stem Cell Therapy that I investigated a year earlier. The question I had was why wasn’t this covered. My choice, if I were still in pain, would be to use pain relievers. In this era of Opioid abuse, why would insurance companies be fighting this coverage and why is the cost so high? My specific therapy that was explained to me would be extracting my own STEM cells from my own fat and reintroducing them at the appropriate spot to stimulate growth. Why is the cost so high?

I now have access to money and if I were in enough pain, I would do it. I was told that this is the perfect time to do it and a person with my history of blood clots makes me a perfect candidate. Thankfully, my lack of pain gives me the ability to think it through and when I do, I get angry…very angry.

Medical marketing to a population in pain that is largely on a fixed income for the promise of pain relief through intervention that is cost effective comparatively to some other procedures is infuriating. This is a perfect fix for people who are dependent on pain relievers and the refusal of insurance companies to cover this procedure pushes patients into creating the necessity for more expensive and invasive procedures in short order. The amount of marketing through TV and Internet represents an enormous cost to the doctors and the behavior in the office makes it almost predatory. “Get this now and I will discount the procedure…” means it is already unreasonably high to begin with.

I am glad that my pain has subsided for now and I will continue to follow good nutritional practices which Dr. Gundry says will activate the STEM cells to repair damage done by inflammation over the years. He too sells far too many products that are marketed to people who want a quick fix for their weight and health issues. After reading his book, it seems to contradict what he preaches. As Dr. Hashimoto said when I asked him what the medical establishment is doing to solve the insurance issue…”healthcare is a business”. STEM Cells may be the next major step in fixing many of our medical problems…but it seems like it is just bad business for insurance to cover it. I don’t completely understand why because it seems like it would save them money and possibly lower costs to their subscribers. Oh, wait…maybe I do understand after all.

A Whole New Me