Friday, September 21, 2018

For Nine Hundred a Month you’d think that…


I pay $900 per month for health insurance.   For that I get a high deductible followed by a thirty percent co-pay that eventually tops out at $4,000 (in network).   Most years I don’t make the deductible amount because I’m afraid to go to the doctor.  I believe that the word ‘deductible’ has come to mean ‘bend over, this won’t hurt a bit.’

I used my insurance this year.  Ankle surgery was necessary to correct ligament and tendon damage due to ‘chronic ankle sprain’.  It hurt to walk prior to the surgery and the surgery to correct it hurt my pocketbook.  A lot.

The Twin Cities has a lot of good medical and surgical options available and I opted for the surgical clinic that did my hip three years ago.  The clinic is affiliated with all of the medical insurance plans.  I called my insurance helpline to double check, though, just in case. 

“You’ll need a referral from your primary care provider,” they said. 

“But my insurance says that this clinic is in-network,” I said.

“You have to switch to another primary care provider to have the clinic actually BE in network,” they said.  “But we can do that for you as of the beginning of last month, no problem.”

I went through the paperwork by phone and two days later had another insurance card with my new network listed.  The required primary care facility was over an hour away from my home and I did not think to call them for an appointment.  I’ve always seen a doctor at a clinic near where I live. 

I scheduled my surgery and necessary pre-operation physical.  The physical came first.  According to new standards, I now have high blood pressure.  Actually, my BP is about the same as it used to be but they lowered the range of acceptable and I now fall on the high side of the scale.  My doctor looked at her online iPad which told her that I need to be on some sort of med because I am 64 years old.  Having a tantrum did me no good.  I bought the prescription. 

After a return trip to check on my blood pressure, which went low enough after taking the prescription to actually put me to sleep, I was declared fit.  The surgery was done and I was out of the clinic in a couple of hours.  I looked forward to an uncomfortable and long recovery.

The bills started to arrive.  I paid my portion of the bills and watched as I neared the $4,000 out-of-pocket costs.   One invoice was listed as out of network but I didn’t question it since it was for my pre-op physical.    ‘Big deal’ I thought. 

At least that was okay until I had my colonoscopy that had been referred by my local pre-op doctor.  Suddenly I owed more than a thousand dollars over the deductible.  I called my insurance company.  I questioned their billing tactics and yelled at the first actual person who answered the phone.  Even my prescription-controlled blood pressure blew up.

Insurance companies hire really good and patient customer service reps.  I believe about thirty percent of my premiums go toward their salaries.  Insurers know that every claim that is denied will be disputed by irate, nearly bankrupt old people who probably didn’t follow the instructions.  The rep’s job is to sympathize and empathize and agree with us that the system sucks completely and that someone should go after those execs who write the stupid policies. 

Those guys are good.  I calmed down.  I relied on their expertise to fix whatever problem had occurred.  I have no idea what happened or how the problem got resolved but I now have a new primary care clinic that actually allows me to go to the doctor I already see.  What a relief! 

A few days later, I received a complaint form in my email.  It requested that I detail the issues and asked if I wouldn’t mind making suggestions as to how to fix the issues.  Basically, it said “You whined and now we want you to formalize the whining.”

I couldn’t remember the problem.  Apparently those same customer service reps have the power to make one forget everything that happened.  I deleted the form.  I also received one in the mail, just in case I had deleted the email form.  This extra expense probably accounts for another ten percent of my insurance premiums.

I always try to make a point with my little essays.  Here’s today’s lesson. 

We have managed to screw up our healthcare system, our insurance system and the doctors who are supposed to take care of us.  It now costs more than ever (and, by the way, my insurance went up by six percent this year… it did NOT go down as was propagandized) to insure ourselves and we are afraid of going to the doctor because the premiums and deductibles are so high. 

Somehow, though, the insurance companies have made themselves more powerful, more able and more a part of our lives than ever.  We have to ask the health insurance companies for permission to go see doctors.  It doesn’t always seem that way, but when we have a problem, we are guided toward the right places by patient advisors who make us feel lucky that we met them.  While we do our best to care for ourselves, we are becoming fully dependent on someone else to tell us how we are actually allowed to care for ourselves, what specialists we can see and when. 

There may be a good result in some ways.  Maybe the insurance companies will guide us toward losing weight and ultimately be our perfect caretakers.  Wonder how much of a premium I’d have to pay for that kind of service?

Gotta go.  I have to call my customer service rep and ask for some investment recommendations.

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