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Posts Tagged ‘medico-insurance complex

“Health care reform” — words, words, words

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True story.

I stepped on a partially open manhole cover once, ending up doing the splits with one leg completely in the hole and one leg out.  Smashed up, cut, scraped, and bruised just about everything below my waist.  But soon everything seemed to be healing well.  On the way back from a vacation on Jekyll Island, a tiny red spot appeared just where my deepest bruise had been, right near my right knee.  On the flight back it kept getting larger.  And hotter to the touch.  And more painful.  So I went to the emergency room on getting back home.  (It was Sunday, and after the UTC hours, so that was my only choice, really.)

The first nurse said, “Oh, nasty bacterial infection there.”  And the second nurse.  And the resident.  The attending, seeing that I’d just got back from a tropical island, decided that I just happen to have been bitten by a spider on the one place on my leg that hadn’t yet healed from my fall, and put me on anti-virals.  Which, the pharmacist informed me, I was lucky to have insurance for, because they were over $300 a bottle without insurance.

The next day, the spot taking over my leg, saw me being admitted to the hospital by the infectious disease guy because I obviously had cellulitis, a bacterial infection, and they needed to pump me full of intravenous antibiotics because I was (ack!) a diabetic.  I had good insurance, a PPO, but had to get approval for all procedures.  So I asked the money person at the hospital ( a vital part of being admitted) how that worked, and was told that the hospital itself would clear all procedures, I had no worries.

On day two in the hospital, a doctor popped her head in and asked if she could talk with me, she was from some diabetic group.  I answered in the affirmative and she gave me the 8th grade level 15 minute lecture on what diabetes was, and the next day came back and spent 5 minutes giving me my first prescriptions and a list of endocrinologists I might want to contact.

Some time passes, and I get a $475 bill from some diabetic group.  Turns out that this group is not part of my PPO circle, and that 15 minute visit and 5 minute follow up is almost $500, more than the rest of my stay in the hospital with my insurance.  There were some rather emotional (on my part) back and forth communications about this, resulting in my bill being sent to a collection agency and my then girlfriend insisting that I pay the bill since we were getting engaged soon and she didn’t want the blip on my credit score.  Gritting my teeth, I paid the money.

In the words of Ron White, “I told you that story so I could tell you this one.”

Now I’m a diagnosed diabetic.  Which means my ONLY insurance is going to come from work.  The next year, the company tells us, “Too many people used their medical insurance last year.  It’s too expensive, we’re going with a cheaper plan.”  The “cheaper” plan, of course, is cheaper for the portion of the premiums paid by the employer, not cheaper for the employee.  Higher deductibles, higher premiums, higher co-pays, higher prescription costs are the result, along with a lifetime limit.

As bad as MY new insurance was, however, new employees to the company had it even worse:  they were offered a completely craptastic plan, health insurance that did not count as health insurance for the purpose of continuing coverage.  Get diagnosed as a diabetic under that plan?  Oh, so sorry, if you switch jobs to a real health insurance you’ll likely not be covered for the first N months to a year because of a pre-existing condition clause.

I was lucky in that I was able to transfer to my wife’s insurance — when I left that company that were talking about offering health savings accounts (HSAs) as the only medical benefit.  Even the HSA provider that they brought in to attempt to sell the scheme to the employees said that she’d never use an HSA if any other form of health benefit was available.

Our current family plan (for my wife, my daughter and myself) is ok, nothing as good as my wife’s former insurance or my former insurance, but not bad for the area.  It has individual deductibles for each family member, so when all three of us came down with strep throat in January this year it cost us (out of pocket for visits and meds) almost $600. Later my daughter had to have surgery (she had a basically permanent infection that was filling and blocking the sinus cavities on the right side of her head) and the out-patient surgery (in and out in 6 hours) was, before insurance, over $6000.  Our insurance doesn’t have a cap, but the second plan in the story above had a $120000 lifetime cap.  A surgery for a daughter here, a couple of hundred dollars a month for diabetic supplies and meds — anyone with crappy insurance is looking at definite problems.

So don’t say that we don’t need health care reform.  Less and less is being offered and even those with insurance are paying more and more for the less.  You may not agree with the public option (which means, possibly, that you are against receiving medicaid, medicare, social security and workman’s compensation insurance), and that’s one thing.  But if you say that the medico-insurance complex doesn’t need reform then you are, not to put to fine a point on it, stupid.  And as Ron White says, that can’t be fixed.

Written by Bill O'Rights

August 19, 2009 at 8:09 pm