I recently obtained a DME (that's insurance-speak for a piece of durable medical equipment, in my case a device that costs just under US$10,000). It was originally prescribed in November of last year.
My then-insurer (a Blue Cross company) required 6 weeks of conservative therapy before they would approve the DME. This is completely normal, and reasonable, since if non-mechanical treatment works, that's better for everyone (except the DME seller, I guess). I completed that in early February.
They then dithered around for months, failing to approve the DME. They also never actually officially declined it, barring my doctors and me from appealing the decision. In addition, we were informed that if they did approve it, they would most likely approve rental, not purchase, which would mean a reassessment every six months. Any delays in reassessment would mean repossession of the DME, and starting the process over again.
I was tempted to just buy myself the thing, and might have done so if it hadn't become obvious that the provider is in no way set up to sell to private individuals. Also, I pay for insurance specifically to deal with expensive medical situations like this, and I am stubborn in this sort of case.
Mind you, what the conservative treatment taught us was that in my case, the only way to control the problem without the DME is basically to become bedridden. For me, this has meant no more than a total of 2 hours out of bed in any 24-hour period. As a result, I have spent the better part of the last year losing muscle tone, being mostly housebound, and generally having a "gee this sucks" situation.
This summer, I changed insurers. The device was represcribed in mid-August, to start the process with the new insurer. The first thing they did was to accept the conservative therapy done earlier in the year as passing that requirement (this was a Good Thing, because if it's been more than six months, they can legally require that I do it again.) Already, I could sense that this might go differently this time.
In mid-September, the insurer sent a list of 12 questions to my doctor. It took the doctor a week to produce the 23 pages of documentation required to answer the inquiries. The answers were received by the insurer at the end of September, when they announced that they would have a decision within 45 days. Two days later, I got a letter approving the DME.
The manufacture, delivery, and training took another two weeks. Bottom line, United Health Care did in eight weeks what Blue Cross refused to do for eight months. I've heard tons of warnings about UHC, but frankly, they've been a pleasure to deal with in this matter. Kudos, also, to my doctor's office. I've heard horror stories from other people about it taking weeks or months to get a 23-page document from the MD to the insurer. (And as an aside, my own physician has been on medical leave for most of this year, so the heavy lifting was actually done by her practice-mates covering for her.)
Basically, everyone has been awesome: the MDs, the physical therapist, the DME rep, the UHC folks. Everyone except the people at Premera Blue Cross. And the kicker is that the UHC insurance is slightly cheaper (when you take into account thing like premiums, copays, out-of-pocket maxima, and so on) than the Blue Cross was.
I now face the challenges of getting back my muscle tone, my stamina, and learning to be mobile again. I consider those to be good problems to have.
I admit that during the whole process, I thought about what it was like to live in a place where universal health care is a given. I thought about my years in Canada a lot. It should not be the case that I only was able to get this life-changing treatment because I have good insurance. Anyone who needs it should have access to it. The US needs single-payer health care, just like any civilized country has.