No, you’ve got it quite wrong

One of the comments on DoubleX’s reader stories of health insurance nightmares:

To the woman with blood clots…

Call your insurance company and ask for their Appeals department. You want to file an expedited appeal. (Expedited appeals are different legally than regular appeals. The company is required to get you a decision generally in less than 24 hours, but it depends on your state’s laws.) In most cases, even if your coverage only carries generics, if there is no generic, they have to cover the name brand. You just have to know how to make them.
Contact your doctor and let them know you’ve requested the appeal so that they can be ready with the medical records.
Look up your state’s Office of the Insurance Commissioner (OIC). They should have a lot of information about patients’ rights. Contact them if you get the run around from your insurance company.

I work for an HMO, and work closely with our Appeals department. It is their job to make things like this right. But the likelihood of anyone at your insurance company telling you this is an option is low, so you have to ask.

No, dear commenter, you’ve got this quite wrong. No patient should EVER have to appeal anything at all when it comes to their healthcare. No patient should ever need to research if there’s a generic or not for the drug they need, whether to survive or just to be comfortable. No one should ever need to contact their state’s Office of the Insurance Commissioner about patients’ rights because insurance companies should simply respect those rights by default. No one, no one should ever have to worry about whether their doctor is prescribing an affordable treatment, whether it be medication or not. No one should ever, ever have to figure out how to make someone pay for the treatment they need, especially not if that someone is legally obligated to pay for it.

And don’t even get me started about preexisting conditions. Is there a human being alive, I mean someone older than a second-old baby, who doesn’t have some preexisting condition? Seriously.

The biggest problem with healthcare reform as it stands today – given the chance that there will be no public option – is that it will be overly complicated and most of us will have no idea how to figure out all the stuff that we’re entitled to get from our health insurance companies, stuff our health insurance companies will surely continue to try not to give us. And so most of us will continue to do what we’re doing now: we won’t go to the doctor unless we absolutely have to because god forbid the thing we’re at the doctor for is something our health insurance won’t cover. I mean if we are lucky enough to have health insurance to begin with. Which means that overall, healthcare costs will remain high because people will go to the doctor only when they have something unavoidably bad and therefore expensive to treat. In no other developed country does spending lots of money on healthcare actually result in worse health than in the United States.