Thursday, July 26, 2007

Becoming Insurance Savvy

I know nothing about insurance. Really, nothing. My crash course in how my insurance actually worked was my second day in the hospital, after having come out of a coma 24 hours before, when a woman from the hospital’s billing department called me and asked what my insurance information was. At that point, I couldn’t feel my feed and my head still felt like it was, literally, full of molasses. Luckily, Jenn had my wallet handy, and I read my information to them over the phone.

A woman with a clipboard was back the next day, while I sat in a puddle of urine from a leaking catheter and a smear of my own blood because my period has started, and said, “You do know that you have a rather high deductible. Can you pay us something right now?”

“Sure,” I said. But I think that at that point, Jenn and the wallet had left, and I was on my own, and I figured I would pay part of that to shut them the hell up as soon as I got the bill.

Because I’d never bothered to submit any of my receipts to my insurance provider. With a $2500 deductible, you just figure you’ve got exactly what I had: catastrophic insurance. Something that’s only useful if you get hit by a shovel, but everyday stuff, all of my antibiotics and gyno costs and birth control costs and the doctor’s visits, I’d just pay all of those out of pocket. I was young and invincible, so I didn’t feel I had to pay much attention to health insurance.

All that changed on May 15th of last year.

I received a $28,000 hospital bill and a slew of other, unrelated bills. The doctors who treat you aren’t actually employed by the hospital. They charge you bills in *additional* to the room and board and machine costs the hospital charges you. So there was a $600 cardiologist bill, a $500 endocrinologist bill, a $400 ambulance bill, and all these random bills for tests, lab tests, I didn’t have any idea what any of these tests were for. There were X-ray charges from when the cardiologist ordered that I get a chest X-ray because I was having trouble swallowing. The endocrinologist later figured out all I had was thrush caused by bacteria from the oxygen tube, and treated it with some $4 antibiotic that I was charged $20 for.

All of these bills were submitted to my insurance company. I had to pay my $2500 and 80% of hospital bill, but after I shelled out 6-7K or so for meds, supplies, my portion of the hospital bill and assorted 80%s of the other bills, they finally started to cover 100% of everything. I’d reached my out of pocket limit, apparently. I wasn’t aware that I had one. I thought I’d always be paying my 80% after my deductible.

With my catastrophic plan, I didn’t have to worry about a primary care doctor or in and out of network or anything like that, I figured, because what was the difference between covering 100% and covering 80% when you were shelling out $2500 a year regardless before you saw any benefit from it?

But, now.

Well, now I have another slew of insurance choices, and tricky things like choosing an “in network primary care physician,” which I’ve never bothered to do before. Why would I choose a “primary care” physician? If it was gyno related, I’d go to a gynecologist. When it was a sore throat, I’d go to a walk-in clinic.

Now I have to see the gyno, an endocrinologist every three months, a podiatrist (recommended) once a year, and the usual vision check every year, plus, of course, anything that comes up as far as complications or additions goes (sore throat, pelvic pain, bronchitis, etc). I go to the pharmacy for meds at least twice a month (I have to pick up testing strips at least that often, and I *should* be getting insulin once a month, but I keep trying to make it last longer than it should).

What this means is that I’ve finally reached the point where I finally have to fully and completely deal with America’s fucked up, confusing, incredibly inefficient and debilitating healthcare system. I have to choose something called a “primary care” physician if I want 100% of my costs to be paid, but it can’t be a truly useful primary care physician for me, like an endocrinologist. It’s going to end up being somebody who does the work of a walk-in clinic and prescribes antibiotics for sore throats.

My new endocrinologist only agreed to see me so long as I was clear that she would *not* fill the role of my primary care physician. She refused to be listed as such, even if, my some strange coincidence, the plan I was a part of had her name on it.

There are a lot of really confusing things in here, and they’re worded really awkwardly like this one under the list of “Limitations and Exclusions” for my new health plan. It says, “Unless stated otherwise, no coverage will be provided or paid for or on account of:” and number 4 is: “Prescription drugs, including insulin and syringes, vitamins, unless medically necessary for a medical condition and nonprescription drugs or medicines, except for diabetes supplies.”


I had to read this three times before I realized they weren’t saying, “We won’t cover insulin.” They were saying “we’ll only cover insulin if it’s medically necessary.”

Which is fine, but that’s a really fucked up way to phrase that, and it made me really apprehensive for about three minutes.

Why is insurance coverage so hard? This shouldn’t be rocket science. This shouldn’t be hard. If you’re sick, you should be able to get better. You should be able to choose the best way to get better; the best doctor, or the most convenient doctor. You should be able to pay your $20 co-pay for anything. Fucking *anything* and go home and get better.

These policies have been written and created to provide the least amount of care possible to the healthiest number of people possible. Which might make a lot of money for somebody else in the end, but is going to ultimately result in a lot of unhealthy and ultimately dead people who aren’t any good to anybody.