Over the last week, the women in our Facebook group have been commiserating about the hard time they have achieving reimbursement from their insurance companies for their health care. I'm starting to sense that for many, they've defined their journey to health as beginning, if and only if…when and only when…insurance will pick up the tab for it. And until that day comes, they sit, feeling paralyzed, defeated, and invalidated.
So I thought I'd share a few of my professional insurance stories with you to give you an idea of how insurance really works. It's not really what you think.
One physician told me several years ago, she knows there is a lot of PCOS in her practice. But since it is a complex disease, she doesn't make the diagnosis. Why? It's not a profitable position. Her exact words to me were,"I make more money writing scripts for runny noses. PCOS is a Pandora's box. And I have medical school loans to pay."
Another physician invited me to lunch awhile back, she'd started a weight management program and she wanted to partner with a dietitian. Excited, I brought all of my PCOS literature along. The lunch was nice, but as it progressed, she explained to me that she was leaving her family practice specialty and moving into cash pay, because there was far more money in the latter. I could tell, she didn't really want to take on PCOS because it would cut into her profit margin. She wrote me after the lunch, saying she decided I'd have to drive too far for the arrangement to work. (I responded by saying I thought that whether or not a job gig was too far should have been MY call…but that's another story for another post.)
Several years ago, I had a meeting with a reproductive specialist in Beverly Hills. He came to the meeting, and like the other physician, explained that he felt he was working way too hard for the money he was earning, and was looking for revenue streams that would fix that. He was hoping I'd do work for him for which he'd keep the majority of the income. He was also writing a screenplay and once he ascertained in a very roundabout way that I didn't know anyone to get it to…the enthusiasm seemed to wane. I never heard from him again.
For 3 1/2 years I was the director of dietary services in a well-known eating disorder treatment center. Twice a week we had staff meetings where we discussed patient progress, and the reports were shared with insurance companies to negotiate for longer stays. We never got what we wanted. The owner of the treatment center taught us that the most successful case managers in insurance companies are the ones who decline the most claims, because they save the most money. It came to a head one time when a woman had been approved by her insurance company, traveled all the way to Arizona, only to find that they reversed the decision while she was en route. She knew the system, however…and she went to check in to a local hotel, called her admissions counselor, and threatened to commit suicide. She was admitted.
The point I'm trying to make here, is that insurance companies, no matter how touchy-feely, warm-and-fuzzy they may sound around enrollment time, don't think of you as women needing help with medical problems. They view each of you as a cost center. PCOS is an expensive diagnosis to treat. And since one in five women has it, if they started approving PCOS claims, they'd put themselves out of business. So they don't like to recognize it.
If you're feeling angry right now, you have a right to. The system is set up to not serve well, women with PCOS. It's not going to change any time soon.
You have a choice about how you're going to deal with this reality.
You can let it defeat you. You can sit on the sofa, watch television, and eat that box of donuts you brought home, out of anger at your situation. It's not really going to help you get better, though. And it doesn't come close to hurting the corporations who have hurt you.
Or…
you can prioritize self-care. You can make a choice to eat better. Exercise a little more. Manage your stress. Sleep more. Take control. You can buy Hillary Wright's book and implement her recommendations. Watch Sasha Ottey's PCOS Challenge TV Show. Join our Facebook group and share ideas. Walk in the upcoming Walk-a-Thon. You can do everything you possibly can to move yourself toward health. You just might lose weight. You just might improve your fertility. You just might feel better.
I honestly don't see the system changing much during my lifetime. There are too many companies with income to lose if true reform occurs. The most I can do, is raise money for research to put information into journals that pressures insurance companies to let you get acupuncture, or take a nutrition supplement, or get mental health counseling. So that is what I do.
It's not fair. It really sucks. So? Are you going to let it disable you, or turn it into the fire underneath you that prompts you to value self-care? We hope you join us in the choice that has a chance of making a difference.