Daniel M’s Story

Daniel MalitoLocation: New York
Conditions:  Rheumatoid Arthritis (RA), Diabetes, Carpal Tunnel Syndrome, and Hypertension (high blood pressure)
Primary Insurance Company: Medicare
Secondary Insurance Company: Blue Cross/Blue Shield
Doctors: Rheumatologist, Nephrologist, Podiatrist, Neurologist and Physical Therapist
Access to care issue: Extended wait time during approval process of a new medication.

I am not Rheumatoid Arthritis. Or, at least, that’s what I tell myself every day. I was diagnosed with Juvenile Rheumatoid Arthritis at the age of 11, but I was sick two years before that. Over the years, the arthritis has precipitated many other conditions – diabetes, carpal tunnel syndrome, and hypertension (high blood pressure) all resulted from the original RA diagnosis. As you can imagine, this has made life difficult at times, and impossible at other times. Getting up every day knowing that you are going to go to bed that night in more pain than you woke up with is a tough burden to bear. We go on, though, those of us who are chronically ill, and live our lives the best we can.

Because of my illness I take more medication in one month than most people take in a year. Right now, I am taking a bio-drug called anakinra, which is given by a self-administered injection every day. I am also taking leflunomide, which is a strong immune-suppressant. In addition, there is the ever-present steroid Prednisone. This is the drug that is the most insidious, as the list of side effects runs the gamut from a simple rash to the much more serious “death.” I also take a host of blood pressure medication and heavy narcotics for pain. It amounts to about twelve different medications per day.

Right now, I am seeing a rheumatologist for my disease overall, a nephrologist for my hypertension, a podiatrist for my feet, a neurologist for my pain management, and a physical therapist to keep everything moving. It’s a wonder I have time for anything else. With this many doctors on my schedule, my medical insurance is a mess, as you may have guessed. I have been fortunate in the insurance department, though, as for most of my adult life I have been covered under my father’s plan since I am disabled. That plan from Blue Cross/Blue Shield was a fantastic plan that never balked ant any of my requests. Now, though, I have switched to Medicare as my primary insurance, and the Blue Cross as my secondary. I am slowly learning that while some things are easier to deal with on Medicare, there are several thing that are much harder to put up with — prescription drugs being the main thorn in my side. The amounts I am prescribed almost always require prior authorization, and many times I have to file an appeal after the request is initially denied.

The way medical insurance companies operate needs to be reformed, badly. It is understandable that the insurance corporations need to make money, but to make patients like me jump through hoops just to obtain the medication we require is cruel and unusual. It is not as if we are requesting these treatments and medications on a whim, there is medical history to back it up. Law makers need to realize this and begin to draft bills that will prevent insurance companies from inflicting real physical pain on their customers while waiting for approval (or denial). For any of you out there suffering from this issue, all I can tell you is to hang on. There are people like us who are working as hard as we can to change the way insurance companies operate. We will succeed, but it is going to take time.