Here's a little exercise that I've come up with, that I've been mulling around in my way-to-full brain today. The summer is fleeting and cold and flu season is around the corner so it's as good a time as any to think about things like getting sick and getting well. There is a lot of talk swirling about health care reform and even more yelling. Now, stop for a second. Take a deep breath. Don't let that blood pressure go up. We're just talking here. Thinking.
M u l l i n g.
Here's what I'd like you to do. Think of 5 things that you LIKE about your health coverage ... if you HAVE health coverage. Think about what you pay. Think about those aspects of the coverage that you use. Think about how happy you are to submit a claim, especially when the medical service or practice won't submit it for you, or when you have to call your insurance company. Think about the advocacy they provide for you, especially if you have a concern about what may or may not be covered by your policy. Think about how easy it is to come up with that high deductible each year or, if you have a low deductible, focus on that. Now, list those 5 things. This is a personal exercise. Don't tell me something that you heard from someone else that was quoting, directly or indirectly from a television program or a thrice-circulated email from your elderly uncle who is "mad as hell and not going to take it anymore!" Think of only YOUR experience. Don't think of your child's experience. Don't think of your parents'. Think ONLY of YOUR experience. Set aside the "what ifs" and focus on your individual likes of your insurance coverage situation. Got your five in mind?
Now, think about what you don't like about your insurance scenario. Can you list 5 things? Can you think of MORE than 5 things. List them. Think again, only, of what has happened to you. Not to your children. Don't think about the percentage of uninsured children in this country, many of whom will lose their coverage as their parents lose or have lost jobs recently. Don't think about freezing of enrollment in the S-Chip programs. Only reflect on your situation. Don't think of individuals showing up at town hall meeting with Congressional Representatives that are hollering "I don't want the government in MY Medicare!" Don't think of the screaming about what-ifs that are leading to fisticuffs. Just focus on yourself. How many dislikes did you list?
Here comes the answers from my list. For the first list I have no answer. I am uninsured. I work. My husband works. I can't buy insurance. I also don't go to the doctor. The last time I was seen, while insured, it was for a serious cat bite that when all was said and done and I was able to keep my thumb, but I was out close to $4000 without any surgery. I'm still paying for that. In my household, in 7 years, we have had to meet at least a $5000 deductible 4 times, with the first year being a $6000 deductible. These weren't services we could have put off for a more lucrative time in our lives; one severely premature baby, a 3 day hospitalization for pneumonia, one pastorella and staph infection of the hand, a hysterectomy and an appendectomy. I've been seen at our local volunteer medical clinic for a weird ear thing more than a year ago and have just learned to live with it because I can not afford additional diagnostics. I was, thankfully, qualified for a funded program to receive an annual mammogram for what I would have checked otherwise after finding a lump under my arm. The directive stands in my home, where I am the one without coverage, that unless I am unconscious or bleeding profusely, I'll just have to tough it out because I can't go to the doctor and I especially can't go to the ER.
Here is my second list's 5 answers. I'll only put 5 even though I could come up with many more showing what I don't like about the experiences (mostly insurance-related) I've had over the last few years.
I don't like that it took 6 doctors in 5 years to diagnose the infertility issues I was having. Doctor #2 actually diagnosed me as infertile after I didn't conceive after two rounds of clomid (industry standard), no imaging and no further testing. That diagnosis gave the insurance their out. They said they did not allow diagnostic charges so instead of my $5000 deductible being credited with the over $10,000 in charges, it was all out of pocket and took care of the mutual fund.
I don't like that I was overdosed with morphine after surgery and wound up in intensive care. I'd never been injured or had surgery that required post-op i.v. pain management. Of course, that overdose had nothing to do with the insurance but the next year I spent fighting with Mutual of Omaha over their denial of the claim for my time in ICU I'd sure like to have back. They said that the 18 hours I spent in ICU was billed at too high beyond their "usual and customary charges." That fight was still unresolved when I had to meet the the chief financial officer of St. Vincent's as my newborn premature baby was in ICU. A social worker in the hospital's employ that was in the ICU, when I told her of the situation, stopped me mid-sentence and picked up the phone to call for an appointment to get me in to see him. She said "you can't expect to have this baby thrive if you have this hanging over your head. This baby needs to be your first priority" and she was absolutely right. The CFO, after my explanation of the efforts I'd made in good faith to get the insurance company and hospital to TALK TO EACH OTHER instead of yelling at me, wrote off the charges. Mutual of Omaha stopped doing business in Wyoming shortly after that.
I don't like that the coverage I had changed while I was expecting baby number two. Due to that change I was not able to deliver him at St. Vincent's. I was told by the insurance company that I could "have" the baby at St. Vincent's but they wouldn't pay hospitalization. I asked what would happen in the eventuality that my baby needed Level III Neonatal Intensive Care, only available at St. Vincent's and not at Deaconess. I was told, though I could not be guaranteed by just the phone call, that the baby would be transferred to the other hospital. The baby, but probably not me. I had a scheduled c-section at Deaconess Billings clinic, performed by my great ob/gyn. He did me a total favor by delivering my son there just to have my insurance cover it. Then this next episode happened.
I don't like that my doctor was told, 45 minutes after I was out of surgery at Deaconess, that even though I had been overdosed with intravenous morphine in a surgery previously and would require fentanyl (all recorded and ordered ahead of time) that Deaconess " didn't have protocol for that drug" so they just weren't going to use it. Imagine having a c-section and having a spinal block wearing off and nothing to follow it up for pain relief. A large belly incision and nothing to stop the throbbing reminder of that incision. Mull that over.
I also don't like that I was charged for my son being circumcised. He wasn't. When I called the hospital billing department to direct their attention to this unnecessary charge, I was told they would have to request notes from the pediatrician to confirm my complaint. I asked "do you not BELIEVE me when I tell you that he was NOT CIRCUMCISED? Do you want me to take a picture and SEND it to you as proof.?" As far as I know, the charge for circumcision stood.
I'll stop at 5 though I have a number of other dislikes of how health insurance coverage, when I had it, and billing fiascoes have played out in my personal experience. What this tells me, again, based on MY OWN EXPERIENCE, is that change has to happen. The way it is working, or more accurately NOT WORKING, must be addressed. The plan for reform that is being offered may not be the best or the most brilliant or fail safe, but it's the only idea being floated right now. If I was hearing from those yelling from the backs of town hall meetings of another idea, I'd certainly like to know their specifics. The truth is, I'm not hearing that. Am I hearing that the health insurance system currently in place is perfect for everyone else except me? If that's the case, then I'll just pipe down and take my multivitamin.
So, again I ask you to write your list. Now, take your list to your Congressional Representative's office and tell them that you'd like the coverage they have. If they aren't willing to share, get them willing to legislate some changes that will make a difference for you and, hopefully, for me. In the meantime, I'll do my best to not get sick. Or injured. Or any more discouraged.