An Apology

Dear. Mr EB,

I had to write this to you because your tears have finally become my tears and your aching has become my aching, your pain, well I share that with you now, as should we all. But not everyone does. We could go on and on about how evil medical insurance companies are, or how your sister labors under her own medical issues to care for you,.. but those are other stories for other times. This is your story as I see it, and I want to apologize to you for not seeing it sooner.

I was there when you decided not to take some of your diabetic medication because of this side effect or that. I was there when the decision was made to order one of the newer GLP-1 agonist that you only had to take once weekly, making it more convenient and less toxic for you. I was even there when we checked several times with your pharmacy and the GLP-1 was still in the approval process for "prior authorization, so it was never filled for you. :I was there when these events began 1 month ago. We were all there.  

And still we're here when, after 1 month your medication has received official denial because the insurance company wants you to try another similar medication before you're treated with the agent your physician prescribed. One Month!!

So I am sorry that it has taken this long for acknowledgement to be made that you've even been prescribed medication that might relieve your diabetic suffering. Of course, the cycles for review of approval or denial are, by policy, at least 3 business days. Yet here are 1 month later only now receiving an expression of awareness that you even exist. By the way, while you were prescribed other diabetic medication, not requiring approval, there was no such acknowledgement. But you refused to take the medication anyway, and they were ok with that.   

But because the review cycle is at least 3 days, the clock is re-set. and so we wait

Unfortunately, your blood sugar, your body and your mind don't use the same clock your insurance company uses. Your blood sugar continues to fluctuate out of control, on a daily basis. mostly in the high 200s to high 300 range. You are asymptomatic now, but your racing thoughts tell you that soon you will become symptomatic. If there is any good news in this scenario, its that in recent months your A1c had decreased from approximately 13 to 9.2, still not normal, but an achievement none-the-less. That progress is in danger of being erased. So yes, your body is not using the same time cycle as your insurance company. 

So I am sorry Mr, E,B,, that this is the way the health system is "caring" for you. One month, and yes, 3 days.  Let's not loose sight of that.

But neither should we loose sight of your other problems.

You live in one small room on the 2nd floor of a row home with a steep stair case that challenges even the fittest among us. You have no hotplate or microwave for preparing meals. You have been diagnosed with COPD, are on Oxygen and continue to smoke.  You have refused to take most of your medication, so there is no real guarantee that you'll take the one the insurance company has denied, and your mental health issues are compounding daily. 

 So if I look at this picture objectively, and admittedly its getting harder for me to even do that, but if I were to objectively evaluate your situation Mr. EB, I would say that an algorithm in our healthcare system has decided that it is time for you to die, Mr. EB. Forget that you are only 53 years old. Let's not consider that you have a sister who fiercely loves you.    Ignore also your humanity and dignity that puts you squarely in the ranks of  all other deserving inhabitants of this planet. None of this matters to the algorithm that says it is time for you to die.

And I apologize for that. But its really a hollow apology.

I should be outraged. And I am.  I am outraged that we have allowed random review time cycles to become policy. Three days for review of prior authorization is a business cycle, not a cellular one and certainly not one born of our humanity.  

I'm outraged that insurance companies Have commandeered the health system and snatched authority from those who went into this profession because they cared about the dignity of human life. he system has been commandeered so much so that despite the best efforts of those of us who really do care about you, you have decided, no you stand convinced that we do not. So you, are are on the verge of giving up.  

 I am outraged because your story is not unique, Mr. E.R. It is far more common than we have seriously acknowledged and has been for the entirety of our 250 year history , and beyond. Ang getting worse. It is estimated that because of recent changes in healthcare policy, 42 million people in the U.S. will either loose their healthcare coverage or will see premium increases. That is not only unjust, it is amoral.

But what I am not is tired. Nor are all of those who really do care about you, tired. Your sister is not tired. Your primary care provider is not tired. We are in this until we can't be in it any longer. But remember, we're working in tandem with each other so that as individuals tire, others will show-up to take their place and the fight continues, the movement, in fact,  gains momentum. 

 Mr. E.B. I am outraged by all that has happened to you and continues to happen.  One month and 3 days is far too long for any urgent medical situation to be reviewed and approved. So I am outraged and I am sorry. But I am not yet tired and will continue to show up for you and others like you, which is all of us. The invitation is for all of us to show up for each other, work in tandem, and the system finally will be made right.

We are all connected and we are each other keepers. 

 Yours, very sincerely,..

 

Neil