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Is It Medically Necessary?

July 23, 2018

If you spend much time around me, you understand that random thoughts come to my mind and I often blurt out whatever nonsense it is. The other night, we were on our way home from spending some time with some wonderful friends out at the lake and I said to my Love Bug, "Why aren't tampons covered under insurance?" She did her normal thing and looked at me like I had absolutely lost my mind this time. Her typical head shake is usually followed by, "Where did that come from?" I had to explain that my mind went from babies (Yes, we got to hold our sweet friends little baby girl at the lake) to monthly cycles then I thought I needed to go stock up on "supplies" and BOOM... Why aren't tampons covered by insurance. Yes, the chain of events in my brain sometimes makes sense, others it is like a pinball machine on steroids. 

 

I am serious. I know that birth control and surgical procedures are covered by insurance companies and while I completely understand that some of this is to prevent serious issues, why is it not all inclusive? Maybe the whole honeymoon thing has my mind focused on everything being all inclusive... It boggles my mind that tampons, pads, condoms, and pretty much anything else related to procreation is NOT covered by insurance. 

 

When I worked for a family practice clinic, we had to prove to insurance companies WHY a certain treatment was "medically necessary" with codes for this and codes for that. Let me tell you, medical coding and billing professionals are way UNDER PAID. While I agree that we should provide proof in some cases, others just seem like a waste of time. Why do we have to get a pre-authorization for something that clearly needs to be done? Why should we call for approval on CT scans or MRIs when the patient absolutely needs them for a diagnosis? Who deems something medically necessary?

If birth control, vasectomies, other sterilization procedures, and childbirth are covered by insurance, then why not the "over the counter" products? Yes, I understand that term should explain it clearly. Its over the counter. I get that. What I don't understand is why? There are a hundred different companies out there that make whatever "product" you need. From diva cups to tampons and condoms to diaphragms. The choices are really endless. Maybe that is why we can't cover them all? 

 

Should we start viewing other medically necessary items that way? Oh, you need a boot for that broken foot? Go down to the Big Box Superstore and pick one up off the shelf. Oh I'm sorry that you can't see at night, just go get some glasses from the Dollar Store. (Yes, I know that they carry those readers super cheap but you get the point)

 

This is just a random thought I had and just don't quite understand it all. Healthcare in this country seems to have gone to hell in a hand basket. We discharge patients who clearly need more assistance with recovery. We refuse to pay for diagnostic testing to obtain a clear picture for a patient's prognosis. Why are we letting insurance companies dictate our care? We under staff units and over load nurses just to take care of sicker patients with fewer helping hands. All because of the bottom line... MONEY. Insurance companies should be ashamed of themselves. Hospitals are losing bedside nurses with experience and are replacing them with inexperienced new grads. I believe I've opened another can of worms and hospital turnover is another post for another day. 

 

Back to the issue at hand. We pay monthly for a "service" that most people are terrified to use because they have a deductible so high that they gotta take a loan out to cover it. People have insurance that doesn't cover hospitalizations or surgeries. No wonder people are getting sicker and the outcomes are more devastating. Coverage is spotty and you have to use a provider in network? What network? The only network I want to deal with is my SOCIAL NETWORK. I shouldn't be limited to who I want to use.

 

Instead of insurance companies, maybe we should just have an across the board charge that people could afford. Instead of charging $7 for a box of tampons and $7000 for anesthesia, maybe make it where we all pay a yearly fee for unlimited healthcare. Maybe this is completely out of the question but there are questions we should be asking.  

I don't know, I am just a girl with a lot of questions it seems. Welcome to my world in which my brain throws random thoughts out on the daily. No telling what is coming next. Happy Monday ya'll. 

#agirlwithalotofquestions #ineedanswers #ourhealthcaresystemissick 

 

 

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