[Courtney] Hello everyone and welcome back.

My name is Courtney, I am here with my spouse, Royce, and together we are The Ace Couple.

And I am here to give you your promised healthcare rant, as it pertains to ketamine.

If you missed the last episode, recommend you check it out.

Ketamine availability for those it would be a life-saving treatment for is something that I am increasingly passionate about.

And there needs to be more awareness about this.

[Courtney] So now that I’ve shared a little bit about my own personal experience receiving doctor-prescribed ketamine infusions to manage my chronic pain, now I want to tell you about the constant headache that is insurance that just refuses to cover it.

[Courtney] As I said last week, and as any of you who may have looked into similar treatments would be aware, they are not especially affordable right now.

They are in fact, oftentimes, extremely expensive.

We’re paying quite a large amount out of pocket for me to have this treatment, and I’ve even seen reports from other places within the country where other patients are getting the same treatments for even a lot more than we’re even paying.

And so it really begs the question why, when these treatments are proven to work for a variety of patients in a way that other drugs have consistently fallen short, why don’t we have insurance coverage for it?

Why is it so expensive and inaccessible to so many people?

[Courtney] We started touching on it a bit last episode, where at the end of the day, it is capitalism and patents and pharmaceutical companies.

And the fact that in order to gain FDA approval, a pharmaceutical company needs to spend an exorbitant amount doing proper scientific testing to prove that their drug does what they report that it does, which makes sense.

That’s a thing we want.

We want some amount of oversight to know that these drugs are safe and effective for what they say it is.

And that involves extensive and expensive testing process before you can even apply to the FDA to show them the work you’ve done and try to make your case.

But that gets very, very tricky when you have a drug such as ketamine that is already FDA approved.

[Courtney] They have just proven in the past that it works for other things.

So over the many, many decades that ketamine has been an FDA approved drug, doctors have learned that there are other functional uses for it.

And now there are many scientists, researchers, doctors who know ketamine can be an effective treatment not only in some instances of chronic pain, but also in some instances of mental illness, such as treatment resistant depression.

So when you have a very effective treatment, and some of the alternatives can have sometimes very high risk side effects, addictive qualities, downsides in general, it naturally follows that the doctors would want to utilize this drug that is just sitting right there if it helps.

And they legally can do that.

[Courtney] Once a drug is FDA approved, a doctor can use their own best judgment to prescribe medications – what they call – off-label.

And if you really only pay attention to off-label and FDA approved by, like, a news cycle and pop cultural point of view, and you haven’t seen firsthand different ways that drugs can be prescribed off-label, then probably the common one that’s been in widespread discussion over the last few years has been like semaglutide.

If you’ve heard people talk about Ozempic or– What are some of the other ones?

Mounjaro, things like that.

You’ll hear, often in the very rage-baity kind of headlines, like, “Oh, look at all of these people taking this diabetes medication and now there’s a shortage of it and they don’t even have diabetes.” Like, that’s been the common conversation.

[Courtney] So that is one instance of: here is a drug that is approved for one thing, doctors have found that it can work in other arenas, so they’re prescribing it to a wider variety of people.

That is an off-label use.

Now, that is an off-label use that has a very bad cultural reputation right now.

But there are so many minor ones that you would never read about in a news cycle.

There are, you know, antihistamines that they’ve learned can help people with anxiety.

Like, there are things like that that are being prescribed every single day.

And for a lot of people, those can be very safe, very effective for what you’re taking that drug for.

And ketamine is no different.

In fact, I’ve even seen one study recently that suggests that 21% of all estimated uses for commonly prescribed medications were prescribed off-label.

[Courtney] So that’s nearly a quarter of all prescriptions are being recommended by doctors for a – quote – off-label use.

And a big part of this is just because of that extremely expensive and time consuming FDA approval process.

Because while we do have an increasing body of studies that show different areas where ketamine can be a safe and effective treatment, those are being done in a clinical research sense, but they’re not being done in an FDA application sense.

We don’t have a pharmaceutical company saying, “Hey, here’s my brand new drug.

It’s different enough from the already approved ketamine that this is ours and we own this.

So we’re going to do these studies.

And here, FDA, would you please approve this for this reason?” [Courtney] And because of how narrow the scope for these FDA approval applications are, it is considered not only common practice, but just good medicine for doctors to keep up on the research and find off-label uses for especially very imminently life-threatening things.

A lot of cancer drugs, chemotherapy drugs, were FDA approved for one specific type of cancer.

But then once they start seeing evidence that it can work for other types of cancers, it is a good thing that doctors are allowed to prescribe off-label so then cancer patients don’t have to wait for sometimes many, many years to get this approval just compartmentalized by every type of cancer that it might help with.

So as a lot of you know, I recently had a surgery that cost me way too much money because our health care in this country is terrible.

We have these insurance plans that basically say we are not going to pay for your medical care until you reach your deductible.

[Royce] Well, to go into a little more detail there, for people who are not used to the sometimes annual process that working Americans have to go through where you’re given an option of different health care plans from your employer, where you’re weighing the possibility of needing to pay for something and trying to– in the future and trying to decide, “Do I want more money taken out of my paycheck at a regular monthly interval, or do I want to roll the dice and see if I don’t have the surgery this year.” [Courtney] Yeah, and it’s so heavily tied to employment as well.

So our health insurance is through your employer, because if I was looking for self-employed insurance, it’s gonna cost a lot more money than going through employers.

Sometimes just paying your monthly premium for health insurance can be cost prohibitive if you are not going through an employer-sponsored plan.

Which– we’re seeing all these fun articles this year about how everyone’s healthcare is going to skyrocket next year.

They’re already bracing everyone for like, “Yeah, your healthcare premiums are going up.” [Royce] Yeah, and so the– you phrased it as you have to meet a deductible before insurance will pay up.

And that’s the general sense, but there are three payment tiers, basically.

There’s: you haven’t met your deductible yet, insurance will cover certain procedures or certain percentages of procedures; and then if you’ve met your deductible for the year, which means you’ve paid a certain amount out of pocket, then you’re in a second tier where insurance will cover more, but not 100% of everything; and then there’s a third tier, which means you’ve met your out of pocket maximum, which is usually – I don’t know – twice the deductible.

It maybe not, it may not– [Courtney] It’s usually twice.

[Royce] Yeah.

[Courtney] It often is.

So, I mean, just to find a nice round number, which in some policy policies is not exaggerating.

10 grand in health insurance, like, costs, before your insurance policy will pay for any of it.

And then once you meet that deductible, after you’ve “Okay, you met your deductible, now you only have to pay 20% of all of your medical procedures.

[Royce] Yeah.

And this resets per calendar year.

[Courtney] Yep.

[Royce] And of course, medical procedures don’t fall neatly into calendar years, obviously.

[Courtney] No.

When I found out I needed this surgery, we had a very real conversation about: do we wait– [Royce] Until January.

[Courtney] –until January for me to have this surgery?

Because then at least least we’ll meet our deductible earlier in the year in case anything else happens.

But the tricky part of that, you’ve kind of got a second side tier for prescriptions.

You have, like, your own individual prescription deductibles that can be separate from your main, like, seeing a doctor in a doctor’s office deductible.

But if you are seeing a doctor or having a service, or getting a prescription that is just something the insurance company has decided, “We are not ever going to cover this,” then that doesn’t even go to your deductible.

They just pretend it doesn’t exist.

So ketamine is one of those things where the insurance company says, “We will not pay for ketamine treatments.” [Courtney] So when I all of a sudden have to have this very expensive surgery, they say, “Yeah, you haven’t paid anything toward your deductible yet this year.” And I’m like, but I actually already exceeded our deductible in the amount I’m paying out of pocket for my health care.

I have all– I have already made it.

And they’re like, “But we don’t see it.

It doesn’t count.” And so now I’m about to tell you a series of conversations I have been having for a month with the insurance company, because I’m so constantly baffled by it.

And even the Americans that I talk to, who know how terrible our insurance system is and our healthcare system is, are still flabbergasted by the way they have been treating this and talking to me.

[Courtney] So I’ll start this off by saying: I have never seen a company try so hard to pretend like they want to help me while not doing anything actually helpful.

Normally in these customer service situations, if they have decided they are not going to help you, you’re just out of luck.

And they will just say there’s nothing we can do.

But for some reason, they keep calling me.

And they keep having new people call me.

And they keep surveying me about my experience.

And I am like, I have already gotten the message loud and clear that you cannot help me.

Why do you keep trying to help me without actually helping me?

It’s very Luigi-coded.

[laughs] [Courtney] I am like, this healthcare company wants to keep an eye on every unhappy customer.

They don’t actually want to help, they don’t actually want to pay for your healthcare, but they want to keep in consistent communication with you just to know exactly how unhappy with them you are.

Because I swear to you, this all started because I understand insurance.

I know what deductibles are, I know what plan we have.

And yes, we do have a very high deductible plan.

We could pay a lot more every single month for a lower deductible plan, but 99% of the ongoing health care I get every single month won’t be going to that deductible either anyway.

[Courtney] So our decision in our household about do we go with the lower deductible plan or the higher deductible plan is basically: well, if they aren’t going to consider anything we’re paying for towards the deductible anyway, we might as well have a little extra cash in our pockets, because we’re paying cash for all these treatments.

Might as well put it towards the treatment since it won’t go to the deductible anyway.

But it’s always a gamble.

And that is exactly how I have heard every American I know talk about choosing a health insurance policy.

They say, “I am gambling and putting my money on the fact that I’m not going to have a devastating accident, that I am not going to need a one-off surgery.” Because most years with our lower deductible plan, sure, we’re still paying a lot out of pocket, but most years I don’t have to have my gallbladder taken out.

So it’s better that we have that extra money.

[Courtney] But on the freak year where I do have to have my gallbladder taken out, now all of a sudden I have to pay for nearly all of it out of pocket.

And so when the hospital called me– And I have never had a surgery like this.

It’s been kind of astounding with how generally unhealthy I have been throughout my life, actual surgical intervention has not been something I’ve needed.

So a lot of people are very shocked by that, myself and my family included.

But I had always been under the impression that you could have a surgery and they would send you a bill after.

But apparently not this time, or not for me, or not at this hospital.

Because they called me and said, “Hey, you have to pay in advance for this.

It’s gonna be about $9,000 that you need to pay in advance before you come in for your surgery.” [Courtney] To which I was livid.

I mean, how can you expect–?

And they called me a week before my surgery.

My surgery had already been scheduled for a few weeks.

So I’m sitting there on the phone saying, “How do you expect your patients to come up with nearly 10 grand cash in a week?” They didn’t tell me I would have to pay for this in advance when I met the surgeon, when I scheduled the surgery.

And even if I did, that would have only been less than a month, maybe a month tops.

And I was just saying, “How can you do this to people?” They said, “Well, it’s really only because you’re so far away from your deductible.

We don’t always make you pay in advance if you’ve already met your deductible or if you’re close to meeting your deductible.” So basically, they were saying: we know your insurance is not going to handle this, and we don’t trust you to pay your own bill.

So that’s why we need it upfront.

[Courtney] So while I was talking to this woman who was trying to collect my prepayment for surgery, I kind of told her exact specific numbers that this is how much that I have actually paid this year in my healthcare, but they are treatments that my health insurance company does not put towards the deductible.

And she was very sympathetic, but she said she’d worked for an insurance company before, and she said, “If I were you, I would call the insurance company, because sometimes they will make an exception.

If you are seeing a specialist that is, you know, out of network, it’s the only specialist in the area that can help treat you, situations like that, sometimes they will make an exception for you.

You should ask them that.” We didn’t even talk about in-network versus out-of-network.

[Courtney] Even when you have this insurance plan, they just tell you which doctors you are and are not allowed to see.

And then even if you’re getting an approved procedure, if you go to an out-of-network doctor, you might still have to pay completely out-of-pocket for it.

And in our case, only– Well, at least up until we meet this extremely high deductible, the only healthcare that’s paid for is certain aspects of primary care at clinics that are owned and operated by the insurance company.

Which I think is dystopian.

And probably shouldn’t be allowed.

But they allege it’s actually better for us.

[Courtney] Because I’ve had friends who are doctors who have opened their own private clinics, and I’ve heard them talk about the process to form a relationship to become an in-network doctor with certain insurance companies, and the doctor basically has to ask the insurance company to approve them to be an in-network doctor.

And that approval process is basically: here’s the amount we will pay you for certain services and certain office visits when someone with our insurance comes to you, take it or leave it.

And so there have been instances of doctors that I know personally who have been through this process and said, “Yeah, my work is actually worth more than this,” and there’s no room for negotiation.

They just say, “Take this or leave it.” And if you leave it, now you don’t get to be an in-network doctor for that insurance provider.

[Royce] Yeah, the whole history of health care insurance in the states is basically just one long racketeering campaign.

[Courtney] It’s such a mess.

And I mean, all the ways our health insurance system is a detriment to our actual health care as individual patients, like, aside.

I took this woman’s advice at the hospital.

So I called the insurance company and I gave them the specific amount that my regular health care costs in order to keep me as functional and happy and healthy as possible, which involves seeing two different doctors, one of whom is my ketamine doctor, and two different prescriptions.

The ketamine being the more expensive of these two, but they are both ongoing treatments.

I explained to them what the cost was, how there were absolutely no known alternatives that haven’t already been tried and failed.

And at first I wasn’t even asking them to cover those charges.

I was just asking them, please, is there anything you can do to pay for more of my surgery?

I understand these are not covered doctors, these are not covered prescriptions and services, but having a gallbladder surgery usually is.

Normally you would pay this.

[Courtney] And of course they’d say, “Well, you haven’t met your deductible.

You haven’t met your deductible.” It’s like, I know I haven’t met my deductible, but that is such a made up number.

Like, you made this up!

And you made up the rule about what counts toward the deductible!

And it’s all a myth.

And they said, “Well, no, we can’t help you.” But they said, “Maybe you can call the hospital.

Sometimes you can negotiate with the hospital.” And I said, “The hospital’s the one who told me to call you.” And they were like, “Oh, well, in that case, you’re out of luck then.” And I did call the hospital back and I said, “If I need to pay for this all out of pocket anyway, can you give me the cash price for this surgery?” Because sometimes, for some reason in this country, a certain surgery or procedure at a hospital might actually be cheaper for uninsured people who just pay cash as opposed to the insurance company.

[Courtney] Because the insurance company, you know, sets or negotiates all the prices.

And I have seen evidence of some situations where, you know, it’s only $8,000 if you pay cash out of pocket.

So I was like, give me the cash price for this.

And unfortunately, in this instance, the cash price was more expensive.

So I said, “Okay, fine.

I will go through insurance then and still pay pretty much everything.” But the very next day, someone from the insurance company called me to give me a survey about how satisfied I was with the customer service I received the day before.

And having worked in a call center way, way, way back in the day, I know how heavily they can discipline customer service representatives for unhappy customers, even if it’s the company’s policy that is making them unhappy.

[Courtney] Every question that was like, how did you like your agent?

I was like, she was great.

She did exactly what you trained her to do.

She did everything right.

And they were like, what about, like, do you feel like your situation got resolved?

I was like, no, not at all.

Not even a little bit.

You made it abundantly clear that you cannot and will not and do not want to help me.

And so I was really– And the fact that it was a human person calling me to ask me these survey questions too is unusual.

[Royce] There are sometimes, for whatever reason, you take the time out of your day to just go off on a survey.

[Courtney] They called me!

They had a human call me.

[Royce] There are some case– I understand.

There are some situations where you’re like, “Oh, I have a written survey.

I am going to aggressively fill it out.” [Courtney] Sometimes, sometimes.

Sometimes you just– you have a lot of feelings and you gotta take it out on a survey.

But no, I was– And I could hear typing too, because they’d be like– All the questions would be like: on a scale of 1 to 10, how likely are you to refer friends to our health insurance company?

And I was like, “Can I give it a zero?” And she’s like, “No, one is the lowest.” And I was like, “Then a one it is.” But then there’d be like a fill in the box: please elaborate more.

Which is why it surprised me so much that it was a human calling me too.

Because it’s like, you could have emailed this to me, and I might have even ignored it.

But this poor woman is typing, and I hear the keys going as she’s transcribing my fuming rant about how terrible they have been in not helping me at all.

[Courtney] And so the day after that, I get a human person supervisor calling me, saying, “Hello, this is a supervisor at the insurance company, and I understand from your survey response that you have been unhappy with your service.” And I was like, “Well, yeah, I mean, since you called me, yes, bad service.

No service, in fact.” She’s like, “Why?

What’s going on?” So I give her my whole rant, all the dollar figures, all the specific treatments, all the everything.

And this woman was like, “Well, I really want to help you reduce your health care costs.

So do you have a little time right now?” And I didn’t really, but I humored her.

I was like, “Sure, I have a few minutes.” She’s like, “I’m going to set you up on a portal.” She takes me to a website.

She’s like, “Pull up your computer with me here.

Let’s set you up on this portal for the insurance company.” Okay.

[Courtney] And as soon as I’m logged in, she says, “Now I want you to click on that little icon that looks like a piggy bank in the upper right hand corner.

This is our Savvy Shopper Rewards Portal.” [laughs] And she seemed so peppy and excited while she’s giving me this spiel.

And she’s like, “This is where you can come anytime your doctor refers you to a specific test or procedure.” And she goes, “For example, let’s say you need an EKG.

Type that in with me in the portal.

EKG, let’s look this up.” Okay, I humor her.

And she says, “Once you type that test in, you should see all of the in-network providers near you that can do this test.

And some of them, if you’re lucky, will offer a cash back coupon.” And so I’m looking at the results that are coming up as she’s giving me a couple random test examples to type in this search box.

[Courtney] And one came up, it was like, “You can go down the road to this imaging place, and this test will be estimated $482.

But if you go to this specific place, they’ll give you $15 cash.” And she’s pointing these things out, and she’s like, “Isn’t that great?” And I just said, “This is dystopian.” And I have never, over the phone, from a distance, physically felt another person deflate that hard in my life.

I could hear it, feel it, sense it.

The aura wafted in from the phone and I just felt this woman completely melt.

And she goes, “I’m so sorry.

I was just trying to help you reduce your health care costs.” And I was like: but you’re my insurance company.

You are a supervisor at my health insurance, and instead of helping me pay, for this one-time surgery that I desperately need, and instead of paying for my ongoing monthly medical care that I need for my chronic conditions, instead of doing either of those two things, you’re showing me how next time I need to go in for a test, I can get $15 cash from the imaging center.

How is that not dystopian?

[Royce] Well, yeah, when you brought this up to me, I was just thinking, how did they build this network of people who have coupons?

Like, there is a monetary agreement behind this saying, “Hey, we will advertise your clinics to our customers if you pay us.” I’m sure of it.

[Courtney] Mm-mm.

And it’s like, even if I was buying into her bullshit of how great it would be to get $15 back next time I need a test, it’s like, well, I didn’t get $15 back when I had I had to pay $200 for my ultrasound to prove that I needed this surgery.

I didn’t get a cashback coupon for the $200 fee to meet with the surgeon to get that consultation.

And I didn’t get a cashback coupon when I had to pay nine grand in advance for my surgery.

And at that point, if they were like– I think on that portal, most of them were like 15 bucks.

I think a couple were 10.

But I saw, like, one that was like $25 and it was for, again, like an automated $500 service.

Even if they were like, “Yeah, come have your surgery here, we’ll give you $20 back after you pay us 9,000.” At that point, I don’t even want your $20.

This is an insult!

So you pay all that much for what was a 45 minute surgery.

[Royce] Oh yeah, it was very fast.

[Courtney] It was–.

It took– [Royce] That’s how long you were out, at least, unconscious.

There was some prep, but yeah.

[Courtney] So the surgery was what?

Half an hour tops?

[Royce] No, no, you were unconscious for 45 minutes.

We were at the hospital for a few hours.

[Courtney] Oh yeah, I mean it took them longer to put an IV in my silly EDS veins than it took them to actually remove an organ from my body.

[Royce] Well, yeah, that’s ’cause it was the fourth nurse that got it.

[Courtney] It wasn’t even the nurse.

[Royce] Not even the nurse.

The fourth person.

[Courtney] It was– And this is a thing too, like next time I have a surgery, I’m fully going to need to ask them, like, can I provide my own nurse to put my IV in?

Because let me tell you, my nurses at the ketamine clinic know me so well.

They know I am a difficult stick, they know all my weird quirks, but they get it every single time.

[Royce] Yeah, EDS veins are tiny and mobile and most people [sighs] don’t understand when you try to prep them.

Like, “Hey, this is going to be a little difficult.” And they’re like, “Oh, yeah, I– there are people who are afraid of needles all the time.

I’m used to it.” [Courtney] Yeah.

And, yeah, they– they don’t often heed the warnings.

But they truly, the– they had all of the nurses who were on the surgery floor try to stick me with an IV in various places to, like, their max number of attempts that they were allowed to give.

And then they called up an ER nurse from the first floor to come and try to stick me.

Because they were like, “Surely an ER nurse is like putting IVs in emergency situations.

They can clearly do this better than us.” She tried to her max number of attempts.

And after they exhausted all of their options for people, like, nurses who could stick me, they’re like, “Well, I guess it’s anesthesiologist’s problem now.” So we had to wait for anesthesiology to come in, and then she tried to stick me in a lot of very creative places.

[Courtney] And she was about to go in through my neck, because she couldn’t get in through my foot, and it was all very unpleasant.

Because of course, before a surgery, they also dehydrate you.

And I even said to you the night before, I was like: how do they that they are going to get an IV in my veins when I can’t drink water ahead of time?

And turns out they can’t.

They can’t do it.

And they were, like, training a new nurse that day too, and that new nurse who was asking about hospital procedures, was like, “Do I need to, like, ring up and bill for all of these like failed IVs?” And the nurse who was training her was like, “Oh no, we don’t have to do that.” And she was like, “Really?

Oh, that’s great!

We had to do that at the last place I worked.” And I was like, oh great, thank you.

I mean, I appreciate you not nickel and diming me for all of the needles that you can’t properly stick in me.

But apparently that’s a thing in some places.

[Courtney] And like speaking of anesthesiology, I haven’t even gotten a bill for that yet.

I don’t know what amount that’s gonna be, but that wasn’t included in my prepayment.

So that’s cool.

So after this woman at the insurance company deflated because I wasn’t happy about the Savvy Shopper Rewards Portal with an icon like piggy bank on my insurance company’s website, she said, “Well, the last thing I can think of is that we can set you up with a case manager.” And I was like, “What will a case manager do?” And she said, “Well, a case manager will know about all the different things you need for your health care and be able to connect you with resources,” and yada, yada.

And I was like, okay, it might not be a bad idea to have someone who knows absolutely everything that I need.

Maybe this is the person who can actually advocate for me and say, “Hey, there really aren’t any other options.

This is what she needs.

What can we do for her?” So I said, “Okay, have a case manager call me.” [Courtney] Listeners, I would like you to take a moment to think about what you assume a case manager is in an instance of health insurance.

Because whatever it is you’re thinking is not it.

Because everything I might have been thinking was not it.

I get a call once again from someone saying, “Hi, I’m a case manager at the insurance company.

I was told to call you to talk about some different options we have.” And this was a woman who was at least – question mark – a nurse, so knows some things about health, period, I guess.

But what she pitched to me was showing me how to set up their free health and wellness app.

And I almost lost it.

She was like– I said, “I am deeply uninterested in a health and wellness app.” And she said, “If you don’t want the app, that’s okay.

We can just have a nurse set up regular phone calls with you, and we can call on the phone to discuss our helpful health and wellness tips.” And I was like, “What are these tips?” And she’s like, “Oh, they can be tips about healthy diet and exercise and meditation.” And I said, “You’ve got to be kidding me.” No.

[Courtney] I said, “Did they prepare you at all before calling me?

Do you know at all what my situation is?” And she was like, “No, not too much.

I just understand you we’ve been having some issues with–” you know, X, Y, and Z.

And so I gave her the entire spiel all over again.

And she tried to explain to me what a deductible is!

And I said, ma’am, I literally let, like, my insurance license to sell insurance lapse like last year.

I used to own an insurance agency.

I was licensed to sell health insurance in two different states.

I know what a deductible is.

And I also know that for me, most years, lower cost per month higher deductible makes sense because you don’t count any of my care to the deductible.

And I again gave her the exact numbers.

And she’s like, “Oh, okay.

So you do understand your policy.” I was like, “Yes, I understand my policy.” And I also understand that it’s still not really gonna help me to change to a lower deductible, because I’m just in a lose-lose situation with the specific care that I need.

[Courtney] And I explained to her the specific care that I need, and what my diagnoses are, what my prescriptions are, what my procedures are, and everything that I have tried up until this point that has failed.

And she says, “Oh, well it sounds like you actually have a pretty good grasp of your own health care needs.” And I was like, “Yeah?!” She said, “Well, what about, you know, things like diet and exercise?” And I was like, “These are things that I’ve been consistently striving to improve, throughout my life, all for the sake of my health.” I said, “I probably have a better diet than 99% of the people you talk to.

We are vegan, we have our own garden in the backyard.

We grow fresh vegetables.

We rarely eat out.

And in terms of exercise, it might not be the most intense exercise, I definitely can never do high impact exercises, but in terms of being mindful and intentional, I do Tai Chi almost every day.

I have been trying to incorporate weight training for–” are we going on three years of regular weight training?

[Royce] Two or three, yeah.

I don’t remember when it started.

[Courtney] So I was like, I probably, despite all of my chronic pain, exercise more than 99% of the people you talk to.

And the only reason why I can do that is because of the ketamine treatments.

If I didn’t even have the ketamine treatments, then advice on better exercise and diet is so useless to me anyway.

And that’s when she said, “Oh yeah…” She said, “I don’t think this program is for people like you.

I think you actually understand your health insurance policy pretty well.

I think you understand your health and wellness pretty well.

This is more for like, you know, most of the people I call were recently diagnosed with diabetes and they need tips on diet and diet restrictions.” And– And I was like, “Are you kidding me?” Then what is the program for me?

What is the program for people like me?

Because I know I am in isolation, a very rare case, but I’m not the only person in the world who needs treatments like this.

So what are our options?

[Courtney] She said, “Let me talk to a supervisor.

Let me talk to other departments.

I’ll have someone call you back.

We’ll see if there’s anyone here who can help you.” Okay, great.

The same woman with the Savvy Shopper Rewards called me back.

She’s like, “Hi, do you remember talking to me on this day?” I was like, “Absolutely, I do.” She said, “Here’s what we can do for you.

I can send you via email a list of all of the in-network pain management doctors near you.” And I said, “Is that it?” And she’s like, “Yep, that’s it.” I said, “I’ve already got a pain management doctor and a treatment that helps.” And she’s like, “Well, maybe if you go to a different pain management doctor, maybe they can find you a treatment that we will actually pay for.

Because we’re just not gonna pay for your ketamine.

So maybe another doctor will have an idea for a drug that we will pay for.” And I said, “I can’t do this again.” [Courtney] I have seen several pain management doctors in the past, and I said, “I can only go to so many doctors who want to put me on gabapentin and prescription strength ibuprofen before they give up and prescribe me something that I don’t want and I am afraid to take long term, something like opioids.” Or they just tell me I’m flat out of luck and I’m, you know, too young that they aren’t going to give me anything harder than that.

So I said, “Why would you put me through that process again when I’ve already been through it multiple times?

And having had it failed, that’s why I pursued ketamine as a treatment and it works.” And this woman said, “Yeah, so, I’m not in healthcare, so I know that gabapentin is a word, but I don’t know what that is.” Ugh!

So case in point, why are you basically telling me what treatments I can and cannot have when you don’t even know what gabapentin is?

[Courtney] And I was like, that– like, don’t get hung up on that substitute, any other drug, and just say, like, this is the thing several doctors tried and it didn’t work.

Now I found something that works.

What can we do to get some coverage for the thing that works?

And I basically said, you know, when I started this conversation, “I wasn’t even asking you to cover my ketamine, because I’m aware–” Oh, because she also showed me on the portal, she’s like, “This portal, you can look for all the policies and what is and is not covered.” And she had me type in ketamine because she’s like, “I want to show you something.” So we typed in ketamine, and there’s a document in the portal that basically said ketamine is an FDA approved drug for this thing.

There are studies that suggest that it is also beneficial for chronic pain.

A document written by and for the insurance company saying there are studies that suggest this, but then saying therefore we consider this to be investigational.

[Courtney] We see proof that it helps chronic pain, but the FDA hasn’t approved it for chronic pain.

Therefore, we will not pay for it.

And that was just so infuriating to see.

Like, you know it helps for chronic pain.

You have a document here saying, yeah, there are studies that show that this helps.

But the FDA didn’t give it its little stamp of approval for this one thing because a pharmaceutical company hasn’t been through that process.

So I said, “So you’re not going to pay for any of my surgery?” She said no.

“And there’s no hope for you to pay for any of my ongoing chronic, like, pain management?” And she said no.

And I said, “Who can I talk to in the insurance company about what it would take to get this designated as a covered service?” Because I said I am not the only one for whom this is a life-saving treatment.

And she said, “Well, there’s no one here at the insurance company who will do that.

But you could try going to the FDA.” [Courtney] I was pacing on our back deck for this whole conversation.

I almost threw my phone in the frog pond.

Because this woman, who’s not even in healthcare, I don’t even know if she realizes that by telling me to try going to the FDA to get this approved, she basically just told me: why don’t you start a pharmaceutical company?

Find a way to use or administer ketamine in a distinct enough way that you can develop and patent it.

Do the research to develop that in the first place.

Do testing on animals, do testing on humans, apply to the FDA to get the FDA approval, and spend many, many millions of dollars in the process.

Then maybe we’ll pay for your ketamine.

I could not believe that a supervisor at my health insurance company told me to go to the FDA.

Go to the FDA.

[Courtney] And I really, really still don’t understand why they have tried so hard.

Why do they have all of these people calling me?

Why did they have the surveyor call me?

Why did they have the supervisor call me?

Why did they have the case manager call me?

And then the supervisor called me back.

And they’re trying so hard to pretend like they’re doing something.

Here’s how you can maybe get a $15 coupon in the future.

Here’s a list of doctors, which I already explicitly showed you how to search for in the portal when we talked a couple weeks ago.

But I’ll just email you the names.

[Courtney] So all this to say, as ketamine treatments become more widely available, and as ketamine becomes more and more a cautionary tale or the butt of a joke in pop cultural conversations, like we talked about a bit last week, I do hope you keep my story in mind and the stories of people like me, for how abundantly encouraging hearing and seeing and being myself a success story, seeing all these success stories of people who benefit greatly from ketamine treatments, it is equally devastating how tremendously out of reach it is for so many people.

I know I was very nervous to try these treatments, not only from not knowing what to expect, but also having had very little success with most health care throughout my life.

But it’s been an absolute game changer.

My life and health have improved immeasurably.

[Courtney] So I would say, if any of you listeners out there are someone who has considered ketamine treatment for any of these widely discussed off-label purposes that are getting more and more prevalent and as more and more studies showing their benefits come out; if you are someone who does have the means to make it work; if you, like me, were concerned about it, nervous on the fence, maybe I can be one more data point to point to maybe giving it try.

But whether that is you or not, I’d encourage all of you to just keep an eye out for any and every piece of news or legislation that might come up over the years that might make this treatment or others like it more accessible.

I know I’ve certainly started looking at other non-profits and organizations that are trying to advocate for more ketamine treatment accessibility.

[Courtney] And unfortunately, just the way the process works, a lot of them are only looking at, you know, one thing at a time, just like the FDA approval is.

Let’s work on getting this more widely available for mental health, and then we’ll work on it for chronic pain.

Or let’s get this more widely available for folks with chronic regional pain syndrome.

And once we achieve that, we’ll work on other syndromes that can cause chronic pain that might help this.

And so I do fear it may be a very slow process, but I do think it is very important.

But that is going to be all for today.

[Courtney] So, as always, I would love to send you all off with today’s featured MarketplACE vendor, Sarah LuAnn Illustration, where you can find bookish stickers and prints by a neurodivergent aroace non-binary artist.

It looks like Sarah LuAnn also has art classes, which is extremely cool, artist to artist.

I love a good art class.

So if you’re interested in that, definitely check out her website.

But the shop itself has so many great things.

I personally am very obsessed with this piece of artwork featuring an octopus in a bathtub holding a book and a mug of something.

Tea, perhaps.

It looks very relaxed and cozy, and it’s honestly what ketamine makes me feel like while I’m getting my infusions.

I feel just as cozy as that octopus.

[chuckles] So I got a sticker of that octopus.

There are also prints.

[Courtney] There are many wonderful pieces of art that you can get as stickers or prints.

I also got a zine called In the Box.

But if you have any children in your life, there’s actually a picture book by Sarah LuAnn called On a Rainy Day and is billed as a sweet story of a father and daughter’s cozy day together as they wait for a storm to pass.

And that just makes my heart ever so happy.

So links, as always, to find our featured MarketplACE vendor will be in the show notes on our website, as well as the description box on YouTube.

Thank you all, as always, so much for being here.

Thank you for allowing me to simultaneously sing the praises of ketamine infusions while screaming and lamenting about the injustices of our healthcare system.

Please send me good vibes for as much patience as I can muster, because these employees in this insurance company are sure trying me.