Anthem’s “Pathway PPO” Individual plan has physically injured me.

Fri, 10 Feb 2017 04:35:04 +0000

I have been a big proponent of the Affordable Care Act (ACA). The pre-existing conditions clause allowed me to take time off from my career and work towards re-training and building a startup. I’m writing documenting my experience not because of an issues with ACA, but because of a failure of a for-profit health insurance company interfering with my care.

I was diagnosed back in Spring of 2010 with psoriatic arthritis. I was plagued with mysterious pain in all different places, which I originally credited to soreness from snowboarding. It took months to correctly identify and determine what the best treatment was for me. Finally, I was prescribed REMICADE® (infliximab), and have been getting this every 7-8 weeks for 6 years. REMICADE is giving via intravenous infusion. ( I will refer to this as my “infusion” or “treatment”. ) During this time I was continuously employed and had been treated by the same medical group on various HMO/PPO plans and insurers from at least three different employers. Except for a small HMO vs PPO billing confusion (which took a year to resolve), all these insurance policies covered the same medical group for six years. This treatment has worked extremely well. Each infusion costs about $6,000-10,000 and I believe the cost of the drug has doubled in the past 6 years. (As well as the drug fluctuates in cost monthly.)

Anthem on David P. Discher

Anthem’s “Pathway PPO” Individual plan has physically injured me.