Monday, August 10, 2009

Mulling

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.

9 comments:

Alison said...

I've been uninsured since I moved back from France three and a half years ago. After Allan and I got married, we thought about putting me on his policy, but then decided it would probably be cheaper for me to buy my own insurance. All of my own money has gone to pay child support; I can't afford insurance on my own. And it's not that my husband won't provide for me; it's more that I've put off doing the paperwork.

So I sometimes reminisce about France, about giving birth there, about my 5-day hospital stays for my routine births. I remember the surgery I had that one time. And my daughter's adenoid surgery. And my son's three ER visits, and his one hospital stay. I remember these things almost fondly, because none of them caused any financial strain. There was no waiting, when waiting was not an option. There was only care given, care received. And care paid for via the taxes we paid, and our optional mutual insurance.

It boggles my mind that we in this country can't get our collective (*gasp* she said "collective"! She must be a socialist!) shit together and do the right thing regarding health care.

Alison said...

And I totally didn't follow your directive. Sorry.

I got nothin'. Because, you know, I'm uninsured and have not been insured in this country since I left it in late 1992. And all that time before, I was on my parents' Blue Cross Blue Shield. I think BCBS used to mean something. These days, I'm not so sure.

J.R. said...

I like:
- my comprehensive coverage
- the premium discounts for exercise and wellness
- the broad selection of providers I can choose from
- the FSA that I can use to reduce my tax bill
- the fairly low-end hassle that I go through most days

I dislike:
- the long waits to see a specialist (when I was military you'd get an appointment within a week)
- the unbelievable fraction of my bills that are for dental
- the bureaucracy of filing claims knowing that the first time through you always get denied
- basically anything that requires more hassle than my previous (military) plan, where I got my wisdom teeth removed based on a 60-minute consult and a 60-minute surgery the next day

Sarah said...

I like:

- that we only pay $300/month in premiums
- that there's never been a doctor that I've wanted to see but which the plan didn't cover
- that I've never had a problem with a bill being paid
- that I have $15 co-pays
- that my twin pregnancy cost us $0 out-of-pocket


I don't like:

- lack of infertility treatment coverage, which ObamaCare won't change

Anonymous said...

What I like:

1. My wife and I have always had outstanding coverage.
2. Since we were 30 we have lived in the third largest city in the country which (we think) means that there's never a shortage of top notch care.
3. With one exception we have been very healthy and in the case of that exception, the health care infrastructure of this city moved in with MRI's, top flight surgeons and state of the art ICU care.
4. We pay $250/month, my wife's employer pays $1,000/month and funds a $1,000 account. Additionally we have $2,000 of deductibles per year. All up, all in, that's about $16,000 per year and we have never been denied access to a specialist.
5. We are part of a large group so we're probably protected from the insurance company deciding that we're getting too expensive and cutting us loose.

What I don't like:

1. We're terrified of losing jobs because we could lose insurance.
2. When my 2nd child was born, my wife's (still the policy holder) employer was within a day of going bankrupt when my wife was within a day of giving birth. If not for a last minute buyout we could have been on the hook for tens of thousands of dollars and probably had to seek a different hospital to deliver.
3. The game seems to be this: Every time a 'life event' happens (job change, illness), someone else gets to decide if your family gets health coverage. As you get older, you and your family are less attractive to insure. A percentage of the country loses every time and has to hang on until they hit 65 and qualify for medicare. Health deteriorates; that's the human condition. Your ability to insure against that deteriorates; that's a market dysfunction.

OK, so I have outstanding health care. I listed three problems, but it's really only one: it could be taken from me, my wife and our three children at any time. And I know I'm not supposed to talk about others, but when I see people lined up for 'health fairs' to get free treatment, when I hear about correctable problems leading to lifelong complications, when people go bankrupt because a health insurance company executive needs to make bonus, I am ashamed of my country.

Sunybuny said...

Justine,

Boy can I relate.
I was an independant contractor for 25 years.so my coverage was under hubby. Then the owner sold out and I wasn't included. then hub got laid off...
so I am not eligible for unemployment, there is no health care for either of us and we are hanging on my a thread.
But we have each other and that is a whole lot.
Wish I had 5 good things to say.

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