I feel they picked my pocket!  Consider what happened to me—I broke my leg (a 4" fibula fracture).  An orthopedist inserted a 4-inch plate, but the surgical wound wouldn't close.  After a month of therapies, Anthony, my wound specialist ordered the KCI’s proprietary V.A.C.® Therapy System.  He got "prior approval" from Oxford, and I was given the necessary equipment—a suction device to wear on my belt, 24 hours a day, specialized coverings that breathed, tubing, waste canisters, etc.  These "supplies," were integral, mind you to V.A.C. therapy.  Nevertheless, Oxford hit me for $1700 saying they were an "uncovered benefit" (whatever that means).

Note: This discussion point is part of a blog-series, "The Short Shrift of Healthcare." See "Reforming Healthcare & Managed Care" on HCPLive.com

Are these supplies any different than requiring a spacer for a child's asthma medicine (puffer) or tubing and a mask for their nebulizer treatment?  Is that different than how insurance companies weasel out of their responsibility with the infamous pre-existing exclusion clauses?   Here's a patient-ER scenario, all too commonplace in the callous world of health insurance:  Insurer, not saying, but implying: "We'll decide later if it was medically necessary. Start your chemo.  We'll review the indications, and we're sorry" if you died/suffered/deteriorated in the process!"

P.S. Why are the "supplies" so expensive?  Because KCI sterilizes and packages this equipment--5 packages to a cardboard boxes that they claim they sterilize.  In other words, you must buy five even when you need one; they charge the patient who is already hurting too much to argue, $237.45 or even $253.30 per box.  Thus, this suppler gets their money and, like the insurance companies, they are escalating the cost of care.

I need to add that while I was at the Wound Center, I saw a number of patients in need of extraordinary wound care (diabetics, peripheral vascular disease) being denied necessary care by their insurers because of contract exclusions, preexisting conditions, bureaucratic delay, or insurmountable hurdles—I am dismayed when it's profits before patient care!