Wednesday, November 07, 2007

Got Him By The Balls.

The question now is whether or not they get squeezed....

I'm going to tell you a story, a Sicko story, about a friend of mine named Chuck. He lives out on the West Coast. Your basic guy really. Works construction, married, two grown boys, he's just doing his life like everyone else.

A couple of years ago as I recall, Chuck was coming home feeling not just tired, but wiped out. Seemed he was feeling that way much of the day. So right after dinner he'd drop off to sleep. He wrote it off to aging.

Well, another problem Chuck was having was that his libido flew south with the birds. So being the regular guy that Chuck is, he didn't notice these changes for a while, and it took his wife, who was fed up with the lack of romance, to finally get him to see something was wrong.

So Chuck called a doctor. He had to leave a message, and so the doctor called back, and basically ran off the symptoms Chuck was experiencing. Ah, the light went on. Salvation was at hand. So in Chuck went for some tests.

As it turns out, Chuck has a problem called hypogonadism. It looks like ED, but in Chuck's case there are no underlying problems with the prostate gland. He just isn't making any testosterone any more. The family jewels as it were have lost their value.

Well, the tests confirmed the prostate health and the low level of testosterone in his blood. And now Chuck is on the path of recovery. Part of that requires Chuck to make some life style choices as well as taking his daily dose of testosterone. Sounds like it's no big deal.

Well, the wife still isn't as satisfied as she would like to be. neither is Chuck. So when he brought it up, the doc gave him some samples of Viagra and Levitra, to see if Chuck preferred one over the other.

As it turns out, Chuck preferred the Levitra, and it was helping the romance department. So the doc wrote a prescription. From what I gleamed on the Net, at a couple medical sights, that testosterone is required not only for a man to get an erection, but to keep it as well. So until Chuck got to a level of testosterone in his blood sufficient for both, he needed the help of the secondary medication.

The problem was the cost. One of those little pills cost just under $15. So for sex ten times a month for Chuck, that's about $150. That runs to close to $1800 a year. So he decided to find out why insurance wouldn't cover it. After all, in Chuck's mind and body, it was a temporary necessity if he wanted any kind of a marriage.

The initial response from insurance was that Chuck was taking a recreational drug. Chuck explained that the drug was prescribed according to his diagnosis. So the insurance carrier said they could send some paperwork to the doc, and they would review it and make their judgment from there.

In other words, they grabbed Chuck by the balls.

Now, I'm no doctor. But I've never been under the impression that a prescription is a request. It's usually considered a doctors order based on his judgment of the diagnosis to which it is being applied. And on it are not recommendations, but his orders realtive to how the medication should be taken.

Well, Chuck read the letter he got from the insurance company after they had contacted his doctor. What was once a prescription was now considered a request. It wasn't as if the doctor simply said this is what I ordered and why; now it was a request. An authorization request.

An authorization for payment. Not totally mind you. Chuck would still pay about a third of it. That's his co-pay level. But essentially two things happened. First, what the doctor ordered was no longer seen as the final determination. Second, and this is the crux of the matter, it became about money.

It's not about the fact that Chuck pays the premium, or that his boss pays it as a benefit. The insurance company is getting their part of the contract. It isn't about the fact that this medication is relative to a diagnosis for what is hoped to be a short term situation. Once Chuck can get his testosterone level where he wants it, and learn to manage it, he apparently won't need drugs like Levitra or Viagra. And it isn't about the fact that the secondary medication is helping keep his marriage in a somewhat healthier state by assuring that they can have satisfying sex on a regular basis. isn't that a family value everyone would support?

It's about money.

And so the insurance company is now the ones to make the determination as to what is best for Chuck. No one at his insurance carrier has examined him, and nor do they have the same confidentiality agreement that Chuck has with his doctor. At least that's what he surmises. Nor is the person making the immediate judgment medically qualified to do so. Again, Chuck's judgment.

So if they squeeze, it becomes a huge burden financially for Chuck. One you would think that insurance premiums are good for. Especially when you look at the insurance industry profits even after Katrina. Perhaps though they won't. He's still waiting.

Either way, Chuck's feeling is that his balls are the business of three pair of hands only: once a year by his doctor who says turn your head and cough, his wife's, and his own.


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