Total Perspective Vortex
What really happened to Trillian? Theories abound, but you can see what she's really been up to on this blog. If you're looking for white mice, depressed robots, or the occasional Pan Galactic Gargleblaster you might be better served here: http://www.bbc.co.uk/cult/hitchhikers/guide/.
Don't just sit there angry and ranting, do something constructive.
In the words of Patti Smith (all hail Sister Patti): People have the power.
Contact your elected officials.
Don't be passive = get involved = make a difference.
Words are cool.
The English language is complex, stupid, illogical, confounding, brilliant, beautiful, and fascinating.
Every now and then a word presents itself that typifies all the maddeningly gorgeousness of language. They're the words that give you pause for thought. "Who came up with that word? That's an interesting string of letters." Their beauty doesn't lie in their definition (although that can play a role). It's also not in their onomatopoeia, though that, too, can play a role. Their beauty is in the way their letters combine - the visual poetry of words - and/or the way they sound when spoken. We talk a lot about music we like to hear and art we like to see, so let's all hail the unsung heroes of communication, poetry and life: Words.
Here are some I like. (Not because of their definition.)
Mamas, Don’t Let Your Babies Grow Up to be Smart Girls
(A Trillian de-composition, to the tune of Mamas, Don't Let Your Babies Grow Up to Be Cowboys)
Mama don’t let your babies grow up to be smart girls
Don’t let them do puzzles and read lots of books
Make ‘em be strippers and dancers and such
Mamas, don’t let your babies grow up to be smart girls
They’ll never find men and they’re always alone
Even though men claim they want brains
Smart girls ain’t easy to love and they’re above playing games
And they’d rather read a book than subvert themselves
Kafka, Beethoven and foreign movies
And each night alone with her cat
And they won’t understand her and she won’t die young
She’ll probably just wither away
Mama don’t let your babies grow up to be smart girls
Don’t let them do puzzles and read lots of books
Make ‘em be strippers and dancers and such
Mamas, don’t let your babies grow up to be smart girls
They’ll never find men and they’re always alone
Even though men claim they want brains
A smart girl loves creaky old libraries and lively debates
Exploring the world and art and witty reparteé
Men who don’t know her won’t like her and those who do
Sometimes won’t know how to take her
She’s rarely wrong but in desperation will play dumb
Because men hate that she’s always right
Mama don’t let your babies grow up to be smart girls
Don’t let them do puzzles and read lots of books
Make ‘em be strippers and dancers and such
Mamas, don’t let your babies grow up to be smart girls
They’ll never find men and they’re always alone
Even though men claim they want brains
Life(?) of Trillian
Single/Zero
Tuesday, August 21, 2007
Last November, while sleepily staggering to the bathroom in the middle of the night, I knocked my foot against the side of
I was sitting on the exam table with a bone sticking out of my foot, tears welling in my eyes, an $8,400 balance on the ledger up front and she was lecturing me about shirking my healthcare responsibilities and letting down the team.
my desk. It happened to be my left foot, the foot/ankle which was so badly broken/mangled a few years ago. My foot pulsed in pain the instant I hit it on the desk, sort of like knocking your funny bone. Because I didn’t hit it that hard against the desk I assumed I’d just hit a “sweet spot.” In the time it took me to stagger the few steps into the bathroom and turn on the light the side of my foot was already swollen, there was round bump jutting out of the side of my foot. It seemed unlikely that I’d broken it, and even if I did, what could be done about it? Probably not a whole lot. So I took a couple Motrin and went back to bed.
When I got up the next morning there was a round protrusion about the size of a large cotton ball, red and purple and greenish, sticking out of the side of my foot. Huh. I didn’t think I smacked it that hard, in fact it seemed like I merely bumped into the desk. I could walk on it without much pain, it just felt like a bad bruise. It hurt when it rubbed against the inside of my shoes, but, in general, it didn’t really hurt that badly. At the time I was in the throes of cancer care for my cat and had just plunked down a lot of money and time for some “exploratory” surgery on other parts of myself which required me to take on a part-time evening job to earn a little extra money to bring in some extra income to help for those expenses. I couldn’t afford any additional medical expenses because I was already deeply in debt for existing medical expenses - and I couldn’t take any more time off work for a doctor appointment. I propped a chair next to my desk, kept my foot elevated, put some ice on it at home and took Motrin. At my night job I wrapped my foot in an elastic bandage and wore the most comfortable shoes I owned.
The swelling remained. And remained. And remained.
Finally, in January, the steady pain and pressure on my foot got to be too much for me. So, armed with a new calendar year of sick days and whopping 2% pay raise, I boldly made an appointment with my doctor.
“Trillian,” my doctor sternly addressed me when she looked up from my foot, “why did you wait almost three months to have me look at this?”
“Because my health insurance doesn’t cover all my medical expenses. I have to pay 30% of your office visit fee plus a good chunk of the expense for any lab tests, including x-rays. And if you recall, I had a bunch of office visits and tests last year which my insurance assessed my portion to be $8,600. $8,600 might not sound like a lot of money in the context of the amount my insurance company paid, but, since I’ve already taken on a part-time moonlighting job to pay for the medical expenses I've accrued, $8,600 is an insurmountable and scary amount of money to me. I’ve worked an extra job to earn money to pay $100/month to your fine medical establishment to which I am now in debt for $8,600. For the next 86 months $100 will be sent to cover expenses my insurance company didn’t cover. Since there are not enough hours in the day for me to take on a third job, I have been reluctant to incur any more medical expenses.” I was crying. I was sitting there on the exam table explaining my financial difficulties to my doctor as justification for not seeking treatment for the bone sticking out of my foot.
Sigh, obviously trying to muster compassion, my doctor said, “Trillian. I understand your financial situation and the high cost of health care, but if you don’t take care of yourself you’ll end up with very serious health problems which will cost you a lot more. We’ve talked about well-care versus health-care, Trillian. You can’t let this stuff go. You don’t use your asthma inhaler when you should because they’re too expensive, you put off your physical because you couldn’t afford it, and now you’ve been walking around with what is obviously a broken foot for almost three months because you were afraid of the expense. We’re supposed to be a team in your wellness, Trillian, and your responsibility on that team is to be smart about your health and get in here to see me so I can perform my responsibility when you have a health issue.”
Yes. My doctor lectured me. I was sitting there on the exam table with a bone sticking out my foot, tears welling in my eyes, an $8,400 balance on the ledger up front, and she was lecturing me about shirking my healthcare responsibilities and letting down the team. At that moment the least of my concerns was that I hadn't been a team player.
Okay, okay, I know, I know. I can imagine how frustrating it must be for a doctor to have a patient who doesn’t step foot in the office unless there’s something extreme going on – like a bone sticking out of a foot, for instance. And I can imagine how frustrating it must be for a doctor to have a patient who can’t afford their health care.
In an ideal world doctors, labs, technicians and specialists would be paid a decent salary from some magic pot of gold not affiliated with insurance companies, pharmaceutical companies, employment, corporate, government or religious groups. Everyone would have access to consistently good health care and treatments.
Trill, Trill, wake up! You’re having that dream again, the one where the world is fair and just and basic human needs like shelter, food, safety and healthcare are a way of life, not a privilege.
Please, just 10 more minutes, please, it’s such a good dream, ooooooooooh, it feels so good, I don’t want to wake up, just 10 more minutes…
Okay.
Back to reality.
Back to the doctor’s office.
“Yeah, I know,” I said, humbled, humiliated, ashamed for letting down the team...scared, “It’s just that I don’t earn a lot of money and my health insurance doesn’t cover much in the way of medical expenses and if I don’t have the money to pay for health care, well, what am I supposed to do? I’m already deeply in debt and working two jobs to pay for some office visits, lab tests and an exploratory biopsy. What am I supposed to do? Do you know where I can sell a kidney? What about egg donation? I hear they can bring in a decent amount of money, can you help me sell my eggs?”
“Trillian, this isn’t funny. And by the way I notice on your record you haven’t been to the ob/gyn department this year and you’re overdue for your yearly pelvic exam. I understand healthcare is expensive but look what’s happened to you! You’ve been walking around on what is obviously a broken foot and now it’s reached a level of intolerance, which means you’ve most likely caused more injury and, by the way, more expense, than if you’d just come in here when it first happened.”
Silence.
Silence.
Silence.
“Trill, I’m sorry, but you have to take better care of yourself. You’re my patient, I don’t want to see you suffering. Especially not because you’re afraid of the cost.”
People have told me it’s all about medical codes. The key to screwing your health insurance company, I mean, working the system, erm, saving on medical expenses, is to learn something about medical codes and “work with your doctor” to code your visits and treatments in such a way that the insurance company pays a larger percentage and thus reduce your out-of-pocket costs.
Yes.
You’re supposed to get in cahoots with your doctor and ask them to fraudulently report your treatments so your out-of-pocket costs are small or nonexistent.
If this sounds like insurance fraud to you, well, you’re not alone. It sounds like insurance fraud to me, too. It sounds like a scam of Enron proportion. And yet, apparently, it happens all the time.
And no, I’m not talking about some nefarious deceptive bad people.
I first learned of this practice at my company’s yearly benefit meeting. A perky and smiley sales representative from our insurance company (the big blue one) fielded questions from the audience. One of my coworkers expressed similar concerns as mine: Rising out of pocket costs for what seem like fundamental health procedures. You know, things like mammograms, cholesterol screenings, asthma medications. Things you would think health insurance, especially health insurance from a provider which claims to be interested in the wellness model of healthcare, would cover if not 100% at least a hefty portion of wellness expenses. But no. Our insurance plan doesn’t cover these necessary and fundamental procedures. When called to task on this, the perky rep said, “Well, it’s really just a matter of how your doctor codes the treatment.”
“So, um, we’re supposed to ask our doctor to lie about what they did for us?” I timidly asked.
“Well,” (smile smile smile,) “not lie. Just code it in a different category,” the perky rep said.
This incited a small frenzy of chatter. “But how...?” “What the…?” “My doctor won’t…”
Our one hour session was almost over so the smiling perky rep handed out apple shaped squeeze “stress balls” and bright blue highlighters to quiet the increasingly angry crowd. She reminded us to drop our business cards in the fish bowl on the way out so we’d be registered to win an iPod. Scarily, it worked. Give 'em something for free and they'll sleep like babies. My coworkers were so excited to have a free squeezey apple and new highlighter and a chance to win an iPod they forgot all about their confusion and outrage over having to compromise our ethics and ask our doctors to do the same and lie about our healthcare and commit insurance fraud.
Seriously. My company, as a collective whole, more often than not reminds me of an episode of TheSimpsons. Their ethics can be bought for the chance to win an iPod. Were I of a more vindictive nature when one of them finds out they've got a health issue which requires extensive care and a lot of out-of-pocket expense I would swoop in and remind them how quickly they sold out their ethics for a squeezey apple and chance to win and iPod.
Some of us did refuse the presents and sulked away mumbling about insurance fraud and out-of-pocket expenses and shoving the iPod up that perky...
Mumbling and complaining don’t do any good. Shoving things up perky sales reps' asses doesn't do any good, either. It is what it is. We’re supposed to feel lucky to have health insurance. And yes, I am grateful I have the opportunity to buy health insurance at a reduced price thanks to a bulk discount deal through my employer. However, no, I don’t feel all that lucky about my healthcare costs.
It's kind of taboo to discuss health insurance because so many people do not have health insurance and those of us who are fortunate enough to have healthcare insurance via our employers need to just keep quiet and feel grateful for what we've got. And that's true, to an extent. But we still have expenses. A lot of expenses.* And I feel a need to reiterate this point, we buy health insurance at a discounted rate at work. Most employers don't "give" health insurance to employees at no cost to the employee. There's usually a pre-tax "contribution" and/or a "flexible spending account" which employees pay via payroll deduction. This is really just an insurance premium. Sure, the premium each employee pays is lower than if they went out on their own to buy health insurance, but, keep in mind, the more employees signed up for the plan, the bigger haul the insurance company is getting in one swoop. When you consider a company of 1,000 people has ~700 people paying a monthly premium of ~$78 each, the insurance company is taking in $54,600 a month at just one company. They darned well better be coughing up some volume discounts for employees. Yes, we're "lucky" to have that discounted premium rate, but we are paying for it, in most cases it's not given to us. My company offers a lot of these "benefits." I have the option to buy life insurance at a discounted rate. And a discounted membership to Costco, too. These discount offers are not given to us by our employer because we're such good, hard working dedicated employees. Sales reps approach businesses with these offers to give to employees in an effort to generate business.
Think of your company. If you were a sales rep for your company wouldn't you think, "Where can I make one sales call and garner potentially hundreds or thousands of sales?" You look out your office window at the city and think, "those buildings are full of customers. Customers who work for companies. Companies which have HR coordinators and benefit managers. A-ha! That's it! All I have to do is make a good offer to a benefit manager, have them pass it on to all the employees in the company, maybe make a little song and dance presentation to the employees, raffle off an iPod and voila! Hundreds, maybe thousands of customers eating out of my hand simply because I offered their benefit manager a volume discount for the company! This plan is genius in its simplicity! Tropical island vacation, here I come!" I would think that if I were a sales rep. Well, apart from the tropical island vacation. Maximum leads with minimal work. Spend the day chasing loads of one-off leads which might not go anywhere, or make one visit to an HR department and hit paydirt with potentially hundreds or thousands of new customers. Health insurance is a business. There are sales reps. They have quarterly sales targets and goals. All of us who have employment-based health insurance are contributing to the sales rep's quarterly figures. When you leave your company and terminate your health insurance with that company, who calls you? Not your doctor concerned about your health care costs, not your insurance company telling you, spitefully, that the claim you made six months before you quit isn't covered (that call will come later), no, one of the first phone calls you will get is from a sales rep at your health insurance company wanting to give you a great deal on continuing your health insurance plan.
Until a few years ago we had a lot of healthcare options offered to us at work. The big blue one, as well as a competing health insurance company, along with several HMO plans. We could choose between three dental insurance plans and two vision care plans. These have been systematically whittled down to: The big blue one, the big blue one's HMO, the big blue one's minimal dental plan and no vision care. The HMO is a good plan, especially for lower income employees. Unfortunately here in Illinois the big blue insurance company's HMO plan is notoriously bad in terms of paying the health care providers so very few doctors and almost none of the major hospitals we all use in the city will accept this HMO. I tried to find a doctor and hospital within 30 miles of my home who are in the HMO's network and came up with three doctors and one hospital. Only one of the doctors was accepting new patients and he, yes, he, was located 15 miles from my home and nowhere near public transportation, so he was a total non-starter. The lone hospital accepting the HMO was 20 miles away. Translation: We have no choice. It's the big blue one's PPO or nothing at all. They've squeezed out the competition one by one, as if the other insurance companies were those squeezey stress apples. This is by manipulated design. That's not paranoia talking, that's reality.
Most of my friends have experienced the same situtation. Where they once had several options for health insurance they now have one. Maybe we're still "lucky" to have a reduced premium thanks to large volume buying discounts, but I'm not so sure. I pay $78/month as a pre-tax payment for my health insurance premium. I used to think this was a good deal. I know people who don’t have health insurance at work and they pay $250+/month for basic emergency coverage. But after the past few years I’m not so sure I’m getting a good deal. How would I know? There's no competition for my company's health insurance dollars, so how could I possibly know what rates I would be offered by a competing health insurance company? I could get rates for an individual plan, but that wouldn't be comparing squeezey apples to squeezey apples. And further, sadly, why would I care? It's not as if my company offers other options, I no longer have a choice. So I certainly don’t feel lucky. My out-of-pocket expenses have been staggering. Many of my claims have been denied, yes, denied. I don't think my health issues are that weird or odd. I did have that broken ankle/foot and I have had some female health issues, and I do have some allergy and asthma related problems, but c'mon, compared to most other women my age, women who've had pregnancies and affiliated healthcare, I'm a cheap date. Apart from the allergies and asthma I'm a normal human being with normal, basic medical needs. And yet, many of the tests and treatments I’ve required have been “not covered on this policy” and medications have been “out of formula.” So basically, I’ve been paying full cost for a lot of my health care – all the while paying $78/month for health insurance. $936/year for health insurance which doesn’t even cover mammograms, pelvic exams, cholesterol screenings or asthma inhalers. And that is now my only option. I have no choice apart from declining my company's sole option for a health care insurance provider. Go blue or go away.
To help offset the cost of basic health care, our company, in conjunction with our insurance company, offers a “wellness screening” option once a year. The Wellness Wagon comes to work and we can sign up for “wellness screenings.” $250 gets us a blood pressure, cholesterol, weight and body mass "evaluation." Breast/prostate screenings are an additional $200. Mind you, these are not supposed to replace a physical, these are merely tests, "evaluations" to indicate overall wellness and point out areas we may want to discuss with our doctors. Translation: For $250 they’ll listen to your heart, make you step on a scale, draw some blood and in a few weeks they’ll tell you if you are over/underweight and what your blood pressure and cholesterol numbers are. They don’t tell you if any of this is good or bad, they just give you the clinical results which you can then take to your doctor for further analysis. The additional $200 for a breast/prostate exam is not what it might sound like. $200 gets you a seat in the back of the Wellness Wagon and a paper gown and the pleasure of disrobing and sitting there in that paper gown with your coworkers, even that weird guy in payables, while you wait for a “technician” to feel your breasts or prostate. It’s not a mammogram or prostagram (or whatever they do to guys, sorry, I’m not sure what actually goes on at a prostate exam, but I assume (hope) it’s something more complex than a technician giving a hand job). The Wellness Wagon breast/prostate exam is just a “technician” feeling you up for lumps or bumps. Um. Yeah. Okay. $200. For a self breast/prostate exam. In the back of a truck. With your coworkers. Brought to us by our health insurance company.
Oh, but they do give out apples, bananas, bottles of water, recipe cards for healthy eating and there’s usually a drawing for an iPod. Let us not forget the chance to win an iPod.
Call me skeptical, cynical, paranoid, cheap and prudish, but for $450 I’d rather take my chances at incurring a big bill with an actual doctor and have actual lab tests and the test results explained to me and a diagnosis/treatment, if necessary, administered by a trained doctor or nurse. I'll buy my own swutting iPod. Why would our health insurance company roll a truck into the parking lot, charge us $250 - $450 for a “wellness screening” which is administered by “technicians” and offers no diagnosis or treatment, but does give us test results and the advice to take these results to our primary care physicians? The answer seems obvious to me. But we’ve called me skeptical, cynical, paranoid, cheap and prudish so my answer would be obvious, wouldn't it? You can draw your own conclusions.
So I sat there in my doctor’s office feeling ashamed after having been chastised by my doctor for not taking better care of myself. I know she’s right. After a few days of no improvement I knew something was wrong with my foot. I knew it wasn’t going to just go away. And I had a sneaking suspicion it was somehow related to the broken ankle/foot a few years ago. Yet I did nothing. I did nothing because I was afraid of the cost of the treatment. Let me take a moment to remind you: I don't live in the third world or under a horrible dictator regime trying to kill off the peasants. Yet fear, nothing but sheer, sleep depriving fear of expense was preventing me from seeking medical treatment. My healthcare facility, doctors my doctor works with, are a leading team working on a viable cure for cancer. Just a few floors away from my doctor's office medical miracles are taking place and world life altering research is being conducted. And yet I don't go to the doctor because my health insurance won't cover a foot x-ray. Um. Something's wrong with that, right? I mean, that doesn't make sense, does it?
After a series of x-rays I was sent to a specialist, a podiatrist. It was confirmed that I did indeed break a few bones and they healed improperly and yes, indeed, there were contributing factors based on pre-existing conditions in the foot from the fractures a few years ago. The treatment? A couple injections of cortisone and some custom molded insoles to help support my weakened foot. Or, I could have it surgically re-broken and re-aligned. I think we can assume which option I chose.
Things were better for a few months. I wore the inserts and even though it still hurt, the swelling decreased and generally it was “better.” Not perfect, not back to normal, but less swollen and less painful. I went for a follow-up visit and told the specialist that it was still painful and showed him that it was still swollen, but he said, “Just take Motrin, if that doesn’t help in a few weeks we’ll discuss surgery.”
And then I got a bill for $2,842. My health insurance denied the claim from the podiatrist.
So I just kept taking Motrin.
And thus began a four month journey through insurance company bureaucracy. Oh believe me, this is a journey I’ve made in the past and I wasn’t eager to go again. I called the doctor’s office to go over the bill, all the details, so I would be armed and ready for the phone calls to the insurance company. It was all spelled out on the invoice, and the notes from the insurance company were also included. The denial letters/forms were right there for me to see. The doctor wasn’t lying. I was fully, completely, denied coverage. Not even a partial payment.
I braced myself and called the insurance company. It took me a full lunch hour to get through the voice prompts, often sitting on hold, to get a live person. Once I got a live person on the phone the first thing they told me to do was go to the website to check my account. Problem #1: I have never been able to login to my account with my insurance company. I have repeatedly called their helpdesk and they have repeatedly told me there’s either a) not a problem or b) my human resources department is to blame. Don’t ask me how or why either of these could be true, since I really and truly could not login to a website hosted and managed by an insurance company, not my company, but their rote excuses are a) there’s not a problem or b) blame HR. Which is funnily ironic since HR departments are universally known for denying problems exist.
Let’s take a step back for a moment, shall we? Let’s just say for some reason I don’t have access to a computer, or maybe my internet service isn’t working that day, or I use a Mac, or any number of other probable causes I might be otherwise unable to check my swutting health insurance claims which have clearly been denied by the insurance company. A lot of people, especially senior citizens and low income people, do not have access to the internet. What happens when they have a health insurance issue?
Couldn't make it up if I tried: When my mother was in intensive care, comatose on life-support, my dad got a form from their insurance company. The form had a bunch of confusing information. Under "description" there was a memo saying details could be found online. My dad tried to login to get the information, however, he, too, had difficulty logging onto the insurance company's website. The next day, from the hospital, he called the insurance company. They told him to get in front of a computer and they’d talk him through logging in. He explained that he was in an intensive care ward where his wife was comatose. The insurance rep told him to call back when he could talk while looking at a computer. And then they had the nerve to question my dad why he would "bother" to call them if he wasn’t at a computer. The guy bullied him asking, "How were they going to help him login if he wasn’t at a computer?" That night my dad tried calling and of course they only offer customer service between 8:30 AM – 4:30 PM.
Meanwhile, my dad was freaking out over the forms the insurance company sent, worried beyond consolation that the hospital would pull the plug on my mother due to an insurance glitch or some information he couldn’t retrieve online because he couldn't login to my mother's account. So I took my laptop, cell phone and the forms to the wi-fi lobby of the hospital and called the insurance company. Sure enough, I couldn’t login and sure enough, their helpdesk tried to deny there was a problem. Finally the tech rep had the audacity to tell me that only my mother should be logging into the account anyway. My mother who was comatose and on life-support. She should have been the one logging into her insurance account to find out the details about all the forms about the claims regarding her intensive care.
I was actually able to remain calm enough to say, “Well, assuming my mother wasn’t on life-support in intensive care and was actually physically able to login to her account, what would she find?”
The guy said, “I dunno. I just help with internet issues. I’d refer her to a patient specialist.”
“Okay then, how about if you refer me to a patient specialist,” I asked. I finally got a patient specialist and explained the situation.
She told me I should look at my mother’s online account.
Yes. After I told her I was unable to login, and my mother was on life-support in intensive care and obviously unable to login herself, she turned right back around and told me the info we needed was online.
I don’t know what insurance company employees earn as an annual salary, but based on the cost of health insurance and how little they actually pay in claims, I have a guess it’s a comfortable income. A comfortable income completely incongruent with competence and any skill required in any other realm. If there is a Heaven and Hell, which is not something I contemplate very often so you know that means I feel strongly about this, if there is, if there is devine justice, the tables will be turned and insurance company employees will spend eternity suffering health problems which are endlessly denied payment. They will spend an eternity in pain trying to deal with insurance company employees. And in this version of Hell those of us who've suffered through insurance company nightmares will be granted the eternal satisfaction of denying claims and making insurance company reps suffer the way they made countless scores of people suffer while on the mortal coil. I know, I'm sounding very uncharacteristically vengeful and vindictive these days, aren't I? Yeah. Well. Walk a mile in my shoes and see how you feel. I'll even give you some Motrin for the trip. Maybe I'll even raffle an iPod.
We finally got the situation resolved after many agonizingly long and difficult phone calls. But what that insurance company put my dad through in the process was nothing shy of cruel and inhumane torture. He couldn't sleep, he wouldn't leave my mother for a second because he was so scared about what was going on with the insurance company and his inability to access the information. Doctors tried to reassure him they wouldn't discontinue care for my mother and the insurance rep at the hospital came up to talk to us about the problem with the insurance company. My dad was still scared and still paranoid and frankly, at this point so was I. When your spouse or parent is laying in intensive care on life-support you tend to be a little, well, out of it. A little more emotional than normal. A little less able to sleep. A little tired. And a lot scared. The last thing you can, or should be, dealing with is health insurance issues. You've got all sorts of doctors, specialists, nurses and technicians doing things to your loved one. You feel helpless, you have no control over any of it. You have to just sit there and watch as they do things to your loved one. And rather than concerning yourself with the diagnosis, prognosis, treatment and care for your loved one, you're sitting there worrying about whether or not it's covered by their insurance, how much the co-pay is, and whether or not the doctor is willing to lie and code the procedure so that it's something covered by insurance.
Somehow I can't see my dad pulling a surgeon aside and saying, "So, uh, doc, if you could do a little something with the insurance code on that surgery we'd appreciate it," wink-wink, slipping the doctor a $20 as he shook his hand.
Right. So. Back to my recent journey into health insurance Hell. Even if I could login to the website, what would I find? I’m guessing the very same information I had sitting in front of me: Claim denied. I talked to our HR benefits person. They tried to login as me, and what do you know, access denied, system error. What a shock. He called the insurance company and told them there was a problem logging in. A few days later I tried again and still no luck.
Meanwhile, the doctor called telling me if I didn’t pay the full amount in two weeks they would put me into collection.
The clock was ticking.
I was angry.
C’est la guerre, insurance company, c’est la guerre.
It would take a two volume book with an annotated companion index to discuss what happened after that.
Here's the summary:
It took two months, several phone calls per day, every day, three certified letters, four patient services reps at the insurance company, two HR reps at my company, three insurance company rep supervisors and a patient admin at the doctor’s office to reach the conclusion that, what do you know, I “only” owe $1,092.
“Oops, someone, tee hee, transcribed the wrong code from the doctor’s bill to the claim form,” was the closest thing to an apology I’ve received.
Oh the irony. The wrong code.
Except in this case it was the insurance company trying to fraud a patient.
I’ve been thinking about this a lot because my foot, well, my foot is back to the swollen, painful, reddish-purplish swollen bump it was when the ordeal began. I take Motrin, keep it elevated when I can and, gotta laugh, after toughing it out for several weeks I discovered the custom insert makes the swelling worse. So I’m paying $1,092 for basically: Nothing. I don’t think my doctors are quacks, in fact they’re all highly accredited, experienced and affiliated with one of the top rated hospitals in the country. And I could have surgery, but, at what cost? I can't afford more expenses and there's going to be a point where the hospital and doctors won't let me have a payment plan. They're going to demand payment in full, especially since I already owe them almost $9,000 and was nearly in collections thanks to an insurance company worker who coded my claim incorrectly.
And I simply do not have more money. The $175/month to cover the last 12 months of medical expenses is killing me. What semblance of a budget I had before all this medical expense hit me is gone. Paycheck to paycheck? That's a pipedream for me, I wish I could live paycheck to paycheck. I'm living credit card payment to credit card payment. Why? Because I have bad spending habits? A drug problem? Living beyond my means? Nope. Because my health insurance doesn't cover my basic health care expenses.
I'm seriously looking into selling an egg or two. It's scary, mainly because, not surprisingly, the places where you go to get your eggs harvested and sold are questionable. You can donate them at legit hospitals and clinics, but if you want to sell them, well, that's a whole other back alley clinic.
If you think I'm joking, guess again. I've seriously looked into it thanks to my out-of-pocket healthcare costs. I've learned the market value of eggs like mine. I did the preliminary screening. Two different clinics told me I could get as much as $10,000 each. Healthy (well, apart from that foot), non-smoking, Western-euro-caucasion, above average IQ eggs fetch a good amount of money if you know where to sell them. I could sell a couple eggs and pay off my existing medical debt and have a little left over for whatever I need done to my foot and maybe, maybe even bank a little for future healthcare.
And hey, it's a shot at immortality, right? Looks like I'm never going to put any of those eggs to use in my uterus, might as well let someone else take a crack at 'em, right? Seems like a win-win but I dunno. If I could go to a legit hospital or clinic where I feel comfortable and safe, I'd do it, I'd sign the release forms and do it next week. Heck, I probably would have already done it.
But just how desperate am I to pay for my healthcare? Desperate enough to bring more healthcare costs upon myself if the procedure goes wrong? How would I explain that? "I had all these medical expenses and my foot really hurt so I decided to sell a couple of eggs to a back alley clinic to pay for my out-of-pocket healthcare expenses..." Somehow I doubt my insurance would cover costs to fix a botched egg donor operation. I wonder what the insurance code is for expenses affiliated with botched back-alley egg donor operations.
And that's just it. In the end, there are no guarantees with healthcare. It’s not like taking a car in for repairs. Doctors do what they can, I respect and appreciate they can only do what they can do, the rest is up to the organic composition of the patient. I could go back to the podiatrist but I’m horrified of accruing more huge expenses.
Maybe I should have a difficult conversation with my doctors and ask them to compromise their ethics and commit insurance fraud on my behalf. Maybe after this recent mistake my insurance company “owes me.” Maybe I should feel justified to ask for a breach of honesty. Between my medical expenses last year and now this I’m paying $175/month for medical care and procedures which didn’t cure or even alleviate some pain. Maybe someone owes me something, maybe I deserve a breach of ethics. Maybe in my case it’s the fair thing to do. An eye for an eye and all that.
No. I don’t feel that way. But I’m beginning to understand the steady drip of incompetence and expenses which cause the decay in some peoples’ moral fiber. A few more experiences like this and I’m going to feel a lot more Robin Hood about health care. And don’t forget, let us never forget, I have health insurance. What about all the people who don’t? At several points throughout this ordeal I basically didn’t have health insurance. My claims were all denied. All my expenses were going to be out of pocket. Sure, now that it’s all shaken out I’m relieved I “only” have to pay $1,092. But that still seems like an awful lot of out-of-pocket expense considering I allegedly have a “good” health insurance plan.
I’m not for socialized medicine. It’s not fair and it doesn’t work. You’ve got people trotting in for all sorts of ridiculous “treatments” for issues which aren’t even ailments, sex therapy, for instance, meanwhile someone in dire need of critical health care is wheeled off to a corner or sent home to die because there aren’t enough resources/doctors to help them. Call me callous but I don’t want my tax dollars paying for someone’s sex therapy or breast implants. More to the point, I don’t want my government, or anyone else’s government, messing around with my healthcare. Ever had a problem with the IRS? Yeah, it sucks, they’re overworked, underpaid and bridled with incompetence. Imagine trying to get medical care in that system. No thanks. You’d be dead before they even processed the initial treatment form. And you know how wealthy people pay lower taxes? Well, imagine applying that same principle to healthcare. Those of us in the middle to lower income range would be far down on the list of priorities when it comes to queuing up for healthcare. I know that sounds pessimistic, cynical and paranoid, but, how can I be anything other than dubious when it comes to government?
Maybe if they held a raffle for an iPod I’d feel differently.
*Click here for some staggeringly scary bankruptcy v. medical care costs stats. Today's health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness. Uncovered medical bills averaged $13,460 for those with private insurance at the start of their illness.
