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.
