The touchiest subject of them all.  Medical Insurance.  Specifically medical insurance in the United States.  Now a days of course it’s almost considered politically uncouth to bring the subject up amongst acquaintances, but I’m going there.  I can ramble off statistics about medical bills being the number one cause of bankruptcy and why it is so important to get universal health care in this country.  I could tout of all the reasons why the arguments against universal health care are ridiculous.  How if you think medical care would go down hill or waits would be longer for appointments etc. you may be delusional as we already have those issues, it’s just we have to pay for it out of our pockets. Out of pockets or out of taxes it’s all the same.  But it’s not.  It’s financial suicide for the people in this country.  Medical Insurance companies have all the power and for those of us with chronic disease and/or rare disease it never works in our favor.  So I’ll stop there and get off my soap box.  I obviously have very strong feelings about this as most who have dealt with the medical insurance industry all feel the same way I am sure.  It’s not something anyone who hasn’t dealt with it understands.  Instead I’ll share my experience.  What one person with a chronic illness deals with.  Multiply this by millions and then you get an idea of how big of a problem it truly is.

I have mentioned in previous posts the entire reasoning around why I got into the corporate world.  I did not have a choice.  I needed real benefits and would not have been approved otherwise.  I am not approved for life insurance either and that was determined back when I was 18 for having polycystic ovarian syndrome which is something that effects 1 in every 4 women.  Well, long before this I was on my parents insurance.  This was the life right?  In college, I had nothing to worry about but my grades and paying for rent.  Most of my issues did not come about until right after I didn’t have coverage any more.  I had a job but it didn’t cover my medical insurance so my parents added me to their COBRA plan.  This cost them $800 per month.  That was about as much as my 2 week paychecks at the time so I definitely could not afford to pay them back.  If I was anyone else and did not have parents to fall back on (as many folks do not) I would have been on the streets.  I had my daughter and had been to kidney specialist after kidney specialist with no answers.  This meant a lot of medical bills for tests and appointments.  What it also meant was having a lot of collection agencies after me and hurting my credit report not allowing me to rent an apartment without someone else signing off on it for me.  As if chronic illness wasn’t enough to have to deal with, paying for it adds to the stress and well, as we all know stress certainly doesn’t make the disease we have any better.

I was diagnosed at the Mayo Clinic in Minnesota.  Luckily I was five hours away and able to drive rather than pay for a flight.  They had discounted rooms as when you go there you need to stay for about a week.  The rooms were about the size of a closet.  I had been working with my insurance company long before the appointments to confirm coverage and had been assured by many of their employees at Blue Cross and Blue Shield that I would be covered.  Months later I received a bill for $20,000.  Call after call, it had been determined that many of my appointments and tests were not covered.  I fought it the best I could but could not get anyone to budge.  Blue Cross had decided they would not cover certain items for no particular reason at all.  Just so they didn’t have to pay.  The $800 we were paying them a month obviously wasn’t enough to get full coverage.  I would soon discover there is no such thing as full coverage.  Every insurance company has their loop holes to ensure they do not have to pay and instead can throw their customers down the drain on lifelong medical bill payments.  All of them.  Blue Cross Blue Shield however is the King of them all.  By far the worst company and if can be avoided everyone should stray from them.  They will do everything they can to screw a sick person out of coverage.  If you’re healthy it’s no problem you are set but as soon as you get sick, even if it’s just the flu, they will find a way.  My husband had Blue Cross and experienced this.  He came down with the flu for 3-4 days and had to get Tamiflu for treatment.  The next month blue cross had doubled his monthly payments.  can you imagine?  A perfectly healthy person gets the flu, an unavoidable virus that anyone can get, even if you get the vaccination, and the double payments?  Not that any ailment is avoidable!  Like I said, if there is any discrepancy in health, they will find a way.  We are not people to insurance companies, we are a means of financial gain.  We live in a system in the United States where money weighs more than a humans well-being.  It’s a travesty.  While we are taking steps in the right direction to fix this broken system it remains very much broken.

Fast forward to 10 years.  I have been working ever since, and have made a comfortable life for myself and my family.  Even with the $350 per month I pay now directly out of my paycheck for health care for my family and I, I still average about $15,000 out-of-pocket every year.  How can that be?  Don’t you have an out-of-pocket maximum?  hahaha!  There’s a loop hole for everything folks!  Your out-of-pocket maximum applies for what the insurance companies call “In Network” benefits.  You see, insurance companies have this magical list somewhere where they can determine what they want to cover and what they don’t.  This list is typically updated every year too, when you re-apply for your insurance. All of a sudden soomething they covered last year they may find too many people used and it cost them too much money.  So, to save money, now they just won’t call it “In Network” and will require everyone to pay for this procedure/medication/specialist/scan … you name it.

I was in the hospital a month ago for 3 days.  My kidneys were giving me problems with pain and nausea that had been going on for days and nothing was helping.  My doctor told me to go to the ER and then admitted me.  I had two stones giving my problems.  They were moving around in the kidney but not yet passing.  Just on the verge of passing.  Side bar: they passed 1-2 weeks ago and I have now reached 100 kidney stones!  Milestone for me!  haha bad joke… back on track now.  I have just received a notice from my insurance company that this hospital stay will not be covered and the reason being “We have deemed this hospitalization medically unnecessary”.  NOT a first for me.  When you have a rare disease these notices come in like clock work.  Why?  Many reasons.  For one, insurance companies are not always up to date on the latest research with medical issues and how they need to be managed or treated.  What does this mean for the patient? It means that I have to spend hours going back and forth with the insurance company, hospital, and doctor until we get them to cover it and clarify why it was a necessary treatment.  Why is the doctor involved?  Well, he now has to take time out of his busy schedule to wait on the phone and talk to the insurance company and educate them properly on the situation.  Why the hospital?  They also will need to work with the doctor and the insurance company to justify my stay and the medication required etc.  Unnerving isn’t it?  Imagine that this is happening all over the country for millions of people and we wonder where a lot of our money goes. There are whole departments in every hospital just to deal with the bullshit these companies create.  Eliminate them and I assure you costs would go down.  Most of all, hassle would go down or at least be lessened!  Obviously having a chronic illness wasn’t already enough work with, you know ..dealing with symptoms, social life, family life, work life, and now financial life.  It’s no wonder people have nervous breakdowns!

THEN there are the collection agencies.  The biggest thorn in the ass of Americas insurance industry.  The insurance company sends you a notice of payment in the mail.  Typically to follow you receive up to 3 bills and then the hospital gets tired of sending you mail and wasting their time and cost.  Occasionally a hospital will be willing to work with you to set up a payment plan, but when you start having 10+ outstanding bills on payment plans they don’t really have the patience for it anymore and move everything off  to a third-party to deal with.  This is where things really get frustrating.  I have dealt with some crazy ones.  First you get a few notices in the mail.  Most of them do not want to work with you for payment plans, they want all the money up front and they will push you for it.  Don’t cave.  They cannot make you pay it all.  ONLY ever pay monthly what you can afford and no more.  There is a negative to this.  It will go on your credit record.  Those of you that know the system have given up on your credit score ever recovering (like me) and frankly just don’t give a shit anymore.  Even if you have been in contact with the collection agency be ready for the phone calls, but especially if you have not.  They start out very nice over the phone asking if you received the bill and if you can pay it off.  They call once a week to follow-up, and make sure you have sent payment.  Wait, you haven’t yet?  You have had a lot going on?  Well we need to send payment as soon as possible.  Then I suppose you are flagged.  Phone calls are now every day.  Tone of voice begins to change for those calling you.  After a while it just becomes straight up harassment.  Let’s take that medical bill from the mayo clinic.  They sent it to a collection agency after only sending me one bill in the mail.  The agency didn’t take anytime at all before they were calling me every day and the calls were becoming verbally abusive.  They would make threats to apply this to my credit report (which at the time I was actually worried about).  They had clearly been trained on how to manipulate a person over the phone.  Well if you can afford “this” then you should be able to give us “this” amount of money.  It’s a little scary how these companies enabled their employees to treat sick people this way, or anyone honestly!  Obviously there has been a crack down on the treatment of collection agencies in the last several years as these instances have gone down.  Either that or it’s just that I can afford to pay more off now.

This is all just my personal experience and I have to say even with all of this ridiculousness it could always be worse.  There are people out there with no one to fall back on, without the wherewithal to fight the insurance companies and the collection agencies, or those just now being diagnosed and have a whole new world of these experiences coming their way.  It’s painful to say that this is what you will experience at one point or another, but that is all we have right now.  All we have gained in this country is the ability to obtain insurance without having to go through a company.  Now I cannot be turned down because of pre existing conditions which is a HUGE step.  If I lose my job tomorrow I have the ability to gain coverage.  It may not be the best but it’s something and it’s better than what we had before.  Now we need to start making some real changes on what the insurance companies control, and how much our citizens have to pay out of pocket.  Call me a socialist, but I think our country should pay to keep it’s citizens in good health for the good of humanity.  I’m just a sucker for equality and for caring for people.  All people.  Although I am a true believer that once you go through something like chronic illness, silent illness, or something that may even be fatal, you start to realize that these things are so much more important.  Ultimately the ones who suffer the most with this entire process that our medical insurance system holds now are the sick people, their customers.  A process where the customer is no longer right.  The customers opinion is not longer valued.  The customer is just a method to earn the company money, regardless if it means they lose everything they have, after losing the one thing that really keeps us going.  Our Health.

~Just a Regular Sick Girl