Tackling the Mess in the Front Room, or Why I'm Up at 2 am

Miscellaneous and Personal Stuff I Must Share
41

Waaaaay back when my allergies were first diagnosed the allergist who did so made the the very same suggestion. You might be surprised how often that comes up.

Yes, in an ideal world allergic people wouldn’t have to be exposed to their triggers at all. But we don’t live in an ideal world. Yes, absolutely, if I could afford it hiring a housekeeper really would be the ideal solution. When I could afford it I actually DID hire a housekeeper to do it. I’m not opposed to that solution. The problem, of course, is that it’s wildly impractical right now.

I think the problem is threefold:

  1. A lot of doctors, being on the wealthy side, and trying to offer the optimal solution, don’t think of costs and, without special effort, are not aware of what it can be like being poor.
  2. Since I am poor at the moment, and live in Gary, Indiana, it’s all too easy to assume I’m uneducated, noncompliant, and drug-seeking because that’s the stereotype. Nevermind that inhaled steroids aren’t the sort of thing drug-seekers seek, the system is set up to view anyone poor who asks for something specific in a negative manner.
  3. Cost-cutting can go to stupid levels, so to save a few pennies on a preventive thing insurance coverage is denied, which effectively prevents said prevention, leading to people winding up more seriously ill than otherwise (at which point the impoverished patient, denied preventive care and unable to hire someone else to do housework, is scolded for not taking better care of herself).

This leads to stupidity that if I say “I anticipate being in situation X that will provoke my allergies, can I have Y to prevent problem Z?” I’m told to avoid that situation, and no, I wouldn’t get Y I just need to avoid X.

I’ve given up on that for now, frankly - I’ve expended way too much time an energy on that already. What I need is an insurance company that doesn’t provide perverse incentives to deny reasonable preventive care for my condition, because that is a significant part of all this.

Exactly.

I think the system as currently set up is tilted toward intrinsic asthma. Mine is very extrinsic. If I stay away from my triggers (sometimes easier said than done, as I’m sure you understand) I don’t appear to have asthma. It doesn’t go away, though. It’s still there, even if not active.

So, here’s how the situation usually plays out:

Me: I’m going to be doing housework/yardwork/whatever that I know will trigger my allergies/asthma. Can I have something in advance to prevent problems?
Doc: You shouldn’t be doing that.
Me: I don’t have a choice, I can’t afford to hire someone to do this for me, and the spouse is disabled and can’t do it (he’s my spouse’s doc, too, so he understands that.)
Doc: The thing is, the insurance company won’t approve this unless you having an exacerbation. Which you’re not right now.
Me: So, basically, they won’t approve anything now, but if I get a flare up and have an extensive rash or hives or wind up in the ER from an asthma attack, THEN they’ll approve treatment?
Doc: Basically, yes. They won’t approve it now because you haven’t had any problems for over six months, and if I give you a breathing test right now you won’t even look asthmatic, so they won’t approve it.

So… is it the doctor being an asshole, or the insurance company? I’m not entirely sure. Maybe it’s both. But I care too much about my own health to screw it up to please insurance company rules.

This is almost as much fun as when I had an exacerbation after a bout of genuine flu a couple years ago (yeah, BIG surprise there). The insurance company called me up and scolded me for not getting a flu shot. Um… it’s well documented in my medical records that I am allergic to flu shots and they’re not recommended for me. Read your own damn records! But, of course, half of this seems to be done by going down standard checklists without actually looking at the individual patient. I mean, hell, I get all the other preventive stuff done, maybe there’s a reason I skipped that one? But no… :rolleyes:

Thanks. I am trying to stay chirpy about this, but it’s a struggle. :slight_smile:

Uh-huh - You and/or your husband probably don’t get tagged as “white trash” due to your address, income, and insurance policy when you walk into the doctor’s office. Just a guess.

Since I now have some additional financial resources I didn’t a week ago maybe I can negotiate the occasional preventive inhaled steroid even if I have to pay for it off the insurance. I will discuss it with my doctor at my next visit, since I now have the resources to do such a thing. I can’t tell you how liberating having just a few thousand in the bank can be. I have options I just didn’t have before. If my doc thinks a medication is a good idea and the insurance company doesn’t want to approve it (because they’re “protecting” me from overmedication or something, that seems to be the usual excuse) getting it is still a possibility.

42

I don’t know what this means - I assume it has something to do with your messed-up American medical system.

43

Well, normally I’d link to a wikipedia definition, but they’re off-line today.

Right away, the type of insurance I have declares I am a poor person. As soon as that fact is known, it is assumed I am black, lazy, and stupid. Then, when I show up and am obviously white, it’s assumed I’m white, lazy, and stupid (because if I was ambitious and smart I’d be rich, right?) With my mailing address being in Gary, it is likewise I’m assumed I am black (not really too off base, as the city IS 85% black), poor, and criminal. It hasn’t happened at this doctor’s office, but since I’ve been poor I have frequently been asked “When was the last time you used illegal drugs?” Not IF, but WHEN. The assumption being, based on location, socioeconomic level, and so forth that I must have drug abuse in my background. People have asked me how much I spent on restorative dental work, because it is so engrained that poor people have bad teeth that mine must not be the originals. These things NEVER happened to me when I was middle class and had “good” insurance (instead of what the poor get) even when I lived at the same address (but then people asked why I lived there - I wasn’t black and I wasn’t poor, so why didn’t I move to a “nice” (that is, white) neighborhood/city).

TL: DNR - there really is prejudice towards the poor in the American healthcare “system”. The poor often receive less than ideal care. And yeah, in general the poor are seen as criminal and lazy in the US.

44

So your doctor won’t give you steroids for your asthma because you’re poor? That really is messed up!

45

Options are fabulous, but doesn’t your doctor ever have samples of that stuff? Mine has given me samples in the past of, say, Advair when I’ve had flare-ups - though he knows that I have halfway decent prescription coverage and the copay wouldn’t be a problem for me.

46

I had a spontaneous asthma attack (and delayed using my inhaler) just before I saw the chest doctor at my draft physical in 1969. This did get me a 1-Y classification and kept me out of Vietnam. However, I can’t say if your idea would get analogous results.

47

I went through this last summer. We had to move sooner and more quickly than we had intended from our junky, filthy, large apartment to my small childhood home, which I had not finished de-cluttering after my mom died. Both the apartment and the house had to be sifted through. I’m pretty sure I lost some things I didn’t want to lose. I know I agonized over huge amounts of stuff that probably didn’t deserve it. It was rough.

Now, I can put my hamster in his ball and he can run all over the house! I can cook in my own kitchen and we have had people over several times. Now that I can get to my piano and I don’t feel like I am surrounded by failure, I have started playing the piano again.

It’s been scary to let go, but the rewards are worth it!

48

Not exactly.

It may be he’s not giving me a prescription that he knows my insurance company will deny and that I can’t afford to have filled out of my own pocket.

It may be my insurance company won’t give me steroids until my asthma gets worse, because they don’t see a need for preventive measures they would have to pay for here.

Which, I suppose, might indeed translate into your statement. More accurately, I get second or third rate health care because I don’t work for a large corporation and, since the spouse and I both have pre-existing conditions, there’s no way in hell would could get anything on the private market. As it is, in most states in the US we would have no insurance whatsoever, we’re just lucky our state has this option for people too poor for real Medicaid who are unable to get insurance any other way.

You are, however, correct that that is really messed up.

49

I suspect the samples are going to his patients that have no insurance whatsoever. Arguably, their needs might be even greater than mine.

50

Your story is really flooring me and makes me feel bad. I’ve been going through allergy testing, and am getting ready to get shots soon. At no time did anyone say I just shouldn’t do housework. On the contrary, they are there, *encouraging *me to clean and wash my whole house every week, wash the sheets, etc. And they recommend me pills and prescribed me an epi-pen just because I exhibit shellfish allergies, even though I make it a point to rarely eat shellfish because of this. They go out of their way to be careful.

Being poor sucks, man.

Good job on getting rid of all that stuff, though!

51

I truly don’t understand your healthcare system, and from everything people post here, I don’t think I want to. Well, fingers crossed that some day, some way, you and your doctors will figure out a way to get you what you need.