Another Story: How Insurance Doesn't Work

Here's another story about the prohibitive costs of insurance WHEN folks can actually get it. This was submitted by Anonymous-- sad we have to use that name for stories, but Big Brother is watching.

Hi Spike. While my story may not be that of an emergency situation, I feel it just as important since I have health insurance and pay out the ying/yang for it! Did I mention that I am a retired public school employee? We were paid so well we should be able to afford it. (yeah right)?

Every month goes by and I get a dreaded statement and somehow I've managed to find the money to pay this bill. Upon my retirement, I opted for the $710.00 a month plan with a $1000.00 deductible. For me; well, that's a house payment! After paying this for a few years I opted for the 2nd choice which was $510.00 with a $3000.00 deductible, $35.00 office visit deductible, and a $25.00/$75.00/$125.00 prescription deductible to boot! With my husband 60 and I 55, we are caught in a catch 22. Can't live with it....Can't live without it.

These are some of my observations:

1. The first thing any medical facility asks me upon entering is "do you have your insurance card"? Not hello.... hope your feeling better today....Nice seeing you....

2. I have to make sure our ailments are covered expenses and coded appropriately by the doctor office. If not, well... there goes another $200.00 we pay out of pocket.

3. To make up for the high deductible of our prescriptions, I request higher milligrams and then cut the pill in half. Should I really be forced to do this? I'm a good person, aren't I?

4. I always, always ask if they have any samples that the drug representatives left with them. Keep in mind 1 Boniva pill is $41.00 and although I have a friend that pays $200.00 per pill because she does not have Prescription Coverage, that is still lots of money out of my pocket that I simply don't have.

5. I'm finding that more and more of the doctors I wish to see don't take insurance anymore or have simply chosen not to participate in many insurance plans.

6. Some doctors simply don't need to be in the profession. They see $$$ signs instead of a person. I've had several doctors speak to me while their hand was on the doorknob ready to leap to the next patient. I guess they have a daily quota to meet? I've had a doctor on his cell phone during my visit in the room with him while diagnosing my ailment. Obviously, I don't go to him anymore! And you won't believe this one.. I've had a doctor's nurse tell me and I quote exactly: "If you call the doctor a lot because you are having trouble with the medicine he gave you, we won't be able to see you anymore because we just don't have the time." I don't go to him anymore either!

7. I also notice that many doctors are not willingly offering information and facts about the ailment we are visiting for. In other words, if I ask the correct question, I am rewarded with an answer. I can only guess that their feelings are if they offer too much information then they could have more reason to get sued? Sometimes I find it is like pulling teeth though.

8. Why can't our medical doctors and hospitals get over the entitlement syndrome they have? Why are we forced to wait 3 months to see a professional of choice? We're sick now.. not 3 months from now. My mother just recently ran into this problem with a dermatologist who, by the way, was not accepting insurance anymore. These days, you pay up front and the then submit your claim to the Insurance company to get paid back! She choose not to see that doctor because she simply could not afford to wait. Why is it all about the $ sign instead of patient care? I just saw a TV special about medical care in Great Britain and the care is all about preventative. Doctors actually get rewarded for getting a person to loose weight or quite smoking. Novel idea!

9. My husband and I both went to the same back doctor on different occasions but all within a few short months of each other. He was hurt on the job and of course it was considered a Workman's Comp claim by his employer. On our individual visits, we both had the same kind of regular xray and saw the doctor the same amount of 10 minutes. The only difference was my statement from our private insurance company showed they were billed approximately $600.00 less than he was billed. Does our system really work?

Finally, one last observation. If we are slightly sick or need preventative care, we do our best to treat it ourselves and just don't go for preventative care. If we have an emergency, we are forced to play the game and hope we still don't have a $2000.00 bill along with our monthly insurance premium. I've resorted to growing my own vegetables, setting up a hen house for fresh eggs and meat and am even considering letting a cow graze in the pastures. How's that for keeping our family healthier so we can pay this dreaded monthly insurance premium for the "just in case" emergency! Instead of the "Green" I don't have going out of my pocketbook, I've chosen to Go Green at home!

Use It and Lose It

Today's fun story of how fucked up the insurance industry is comes from Anon who once upon a time had GREAT insurance. Then she used it, thinking, you know, that's what she had it for-- to help her through some health issues. Alas, this came back to bite her in the ass. Consequently, that ass bite was no longer coverable. In fact, the plan she has now hardly covers anything. But it does remind me-- I need to do a post about planning health emergencies for when you're traveling in countries where you can actually get treatment without it costing an arm and a leg. I'll do that soon. And I'll also reveal the results of my Insurance Rejection Letter, which came the other day. For now, the tale of Anon. Please keep those stories coming: spikegillespie@gmail.com.

Anon's Story

Nine years ago I had some pretty extreme headaches and a weird case of inflamed iris called iritis. I had great Blue Cross health insurance at the time through the tv network I worked for and the doctors gave me EVERY test on earth over a period of three or so months. ALL of them came back completely clean. No auto-immune disease, no lupus, no brain cancer, no MS, no problems.

They ended up calling it viral meningitis - but made it clear that they didn't know which virus it was and that it would right itself eventually, which it did. The headaches went away and I haven't had any trouble since. In fact, I felt BETTER knowing that I had been thoroughly tested and prodded and declared clear of all the random things that my hypochrondic-prone brain could dream up. My doctor thought it was probably stress-related.

And then I left the tv network, and my health coverage went with it.

And when I tried to reapply on my own - I was denied by Blue Cross - and then by everyone else. From 2002 on, up until the last time I applied last year. Because OF ALL THE TESTS.

Apparently exhaustive rounds of tests that give you a completely clean bill of health also signal DANGER! to Blue Cross. I would think they'd WANT me because they have medical PROOF that I'm healthy.

Finally I got a $7k deductible plan from Kaiser, in case of anything MAJOR.

Here's the weird thing - when I travel to places like Liberia and Haiti - dangerous-to-health, poor places - I actually have better health coverage because I can buy TRAVEL health insurance that covers me when while I'm gone.

My advice: if you want good health coverage and can't get it in the US, relocate to another country and buy a policy from a company like LIASION, which covers Americans who live abroad. Better than Blue Cross and actually AVAILABLE.

The New Illegal Drugs: Redefining Epi-Curious

So I asked for your stories, and already the mail is coming in. Today, the story of a mother who risked her life because she doesn't have insurance, followed by my commentary. Alisa's story:

Spike,

While mine is not nearly as offensive as so many of the health insurance stories out there, mine is a drop to add to the bucket. I'm a freelance writer/editor and have opted out of private insurance to instead pay for my children's food and rent. A few months ago I was eating a romantic shrimp dinner with my sweetheart and suddenly had my throat swell closed. Having food allergies already, this wasn't a big surprise, but was unexpected nonetheless as I had not ever had a reaction to shrimp. Instead of rushing to the emergency room, as most normal people would do, I stood in the kitchen telling my guy that I thought I was having a potentially serious food allergy. I decided to down some of my sons' children's Benadryl (the only thing we had on hand) and see what happened. Luckily, after about 20 minutes, my throat began to unswell. In retrospect, I realized that deciding between an outrageously expensive emergency room visit and living was, well, ridiculous. I've since gained access to a totally illegal EpiPen from a relative who had an extra on hand. It continues to amaze me every day that the "progressive" country in which I live considers life and death emergencies a luxury of the rich or well-employed.

Good luck to you on this latest venture of yours. I hope it has the expected effect of getting the word out that we, as a country, are continuing in the wrong direction.

Alisa

Alisa's story called to mind a couple of thoughts. It reminded me that I'm allergic to bees, though I'm not sure how allergic. The last time I got stung, about seven years ago, my arm blew up like a balloon. This has left me wondering, if I get stung again, if it will kill me. I used to carry benadryl around all the time, but then a nurse told me that if I'm deathly allergic, that's not going to do jack, and I have about ten minutes to get to ER (and the rest of my life to pay for it). I perform a lot of outdoor weddings and I like to (semi) joke with the attendants that, should I be stung during a ceremony, they better be prepared to do a ballpoint pen tracheotomy. I can't access an EpiPen legally-- no insurance, can't afford the expense of tests to determine my allergy level. So I just hope for the best.

I'm glad Alisa tracked down an EpiPen. For my part, I'm a fan of giving and receiving sundry other pharmaceuticals to folks. I've squirreled away and assload of Vicodin over the years, just in case I can't go for medical attention the next time I'm in agony. I don't love the Vicodin-- sure, it works, but it also makes me paranoid and constipated, to the point that I become highly suspicious of my own asshole. But I've got some here. I've also got some sleeping pills from various sources, which I acquired during sundry anxiety-riddled times in my life, like during my last divorce.

Speaking of anxiety, I have yet to receive the "detailed letter" from BCBS telling me why I was rejected for a group plan. I'm wondering if it was because I disclosed the fact I went to therapy? I downplayed this therapy stuff, which really pissed me off. I wanted to say, when the woman on the phone asked for details, "YES! I went to therapy! It was GREAT! You should try it! We all need therapy!" But I know that the insurance companies don't look at the big picture and see that the treatment we get can lead to better health down the road-- of which I am proof positive: It's been ages since I've had an anxiety attack or bout of serious depression, both of which used to be part of my regular internal landscape. Oh no, they just put the information in their How Can We Fuck This Potential Client Over spreadsheet, and then either flat out reject you or offer a plan that in no way will cover the things we most need covered.

Please send your stories to spikegillespie@gmail.com. Do you have a stash of illegal legal drugs? Tell me about it. Have you removed yours or anyone else's appendix at home on the kitchen table? I want to know.