Wednesday, February 18, 2009

I is for Insurance

A few months ago, Dave woke me around midnight with those three little words every woman wants to hear....

"Don't freak out."

He was wearing his robe (which he never wears) and for a split instant my brain jumped on the fact that one of the kids was missing and he'd gone outside to look for them. Thankfully, this was not the case.

He'd been having mild chest pains all day and around midnight, he'd gone to the bathroom and suddenly started shivering and shaking and couldn't stop. He put the robe on to be warmer but still couldn't stop shaking. That, combined with the chest pain, convinced him he should go to ER. This is a man who is typical in that it has to be a visible bone before he goes to a doctor.

I offered to drive him but he refused and drove himself. Which I thought was stupid, considering he might be having a heart attack!

He was fine. They tested him thoroughly and he has the heart of a lion, which I already knew.

So why am I telling you about this months later? Because I've been saving up this rant for awhile. If you want to skip it, there's a contest from another blog at the end. Really good one, too! Great cause and over 60 yarny prizes!

OK. D went to the ER at the hospital here in Parker. Our insurance is with Kaiser Permanente. We've been contemplating for months about switching to another company. Several reasons:
A) Being self-employed, we pay over $500 a month for something we never use. Our family is unnaturally healthy *knocks on wood*.
B) I've been investigating HSA's and it seems like a much better fit for our family. Doesn't cost too much less but at least we get to keep our money. With KP, it's like throwing money into a hole and then throwing in a flaming torch. And when the flame goes out, throwing in a rabid weasel. (It irritates me, can you tell?)
C) There's no KP place for us to go to in Parker.

C is one of the biggest problems I have with it all. When we first moved here and bought our insurance, we didn't know any better. It wasn't until months later when I was scheduling my annual that we found out. If KP had any integrity at all, they would've pointed out the fact that we were going to have to drive 30 minutes to get to the nearest KP providers. WTF??

When D went to the ER that night, he was taken back right away (as they do with anyone who thinks they're having a heart attack) and once they were sure he was stable, they started all the testing that goes with a suspected MI. He was, of course, there for several hours. At 7 am, I called to see how he was doing (since, obviously, he wasn't calling me and after 5 hours the frantic was overtaking the patience). He told me they had one test left to do but they were going to transfer him by ambulance to a hospital in downtown Denver to do this last test. "Why?", you ask? Because the hospital in Parker isn't a KP provider.

They transferred him to St. J's in Denver. Via ambulance. It's nearly an hour's drive from Parker. For one test.

Does that boggle anyone else besides us?

Again, Dave's fine. They don't know what was causing the shaking but his heart is perfect.

So about a week or so later, we start getting those papers. If you've ever used your insurance, you know the ones. "This isn't a bill, we just want to show you how much money we saved you by having our insurance" papers. They made me sick. They made me furious. They made me want to go find a rabid weasel.

That ambulance ride? Forget the extra cost of checking into another hospital. That ambulance ride alone cost nearly $1000 dollars. One thousand dollars!! For one more test. It seemed so stupid and wasteful. Wouldn't it have been easier (on both the staff and the patient) and definitely cheaper to just leave D where he was and do a little extra paperwork??

We must've received 12 of those papers. For various things around the hospital (well, hospitals really) and the ambulance ride and the testing and the..... everything.

I pretty much demanded D find us another provider ASAP. ASAP for D means he did it at the end of the year. And now we have some lame "temporary" insurance. That whole episode means D might have a pre-existing condition and we've been turned down by 2 other companies now.

Again, I say, WTF?? If anything, it proved he has the healthiest heart in the house! (At least among the adults). It's insanity.

For about a week, we had no insurance. I didn't want anyone to leave the house. Or their beds. For fear of an accident that would bankrupt us. And how sad is that? The fact that something like 40% of people losing their homes right now is due to medical bills! Not just the mortgage fiasco, but people who got involved in the mortgage fiasco by getting 2nd mortgages on their homes to pay hospital bills. It's pathetic and disgraceful in a country of our affluence that this should ever be possible.

Other things in the insurance world that have been boggling me lately...

My FIL has to sleep with oxygen. He has a machine with some mighty long tubing that ends up with a nose cannula. He pays $30 a month co-pay while his insurance company foots another $200 a month for this machine. My FIL did some research and discovered that for a flat $600 you could buy a whole brand-new machine!! And that's at retail prices! So that means between my FIL and his insurance company, they could buy the equivalent of 4.6 Brand New, retail priced machines a year!

He told us he was going to write a letter to the insurance company and we assured him they already knew and didn't care. Why they didn't care is a riddle that would stump the Sphinx.

The midwife (Karen) who birthed D2 needed to get out of midwifery and move back East to help out with a family situation. Her medical malpractice insurance wouldn't let her out of her ungodly, expensive coverage unless she paid them something in the neighborhood of $20,000 dollars. Twenty. Thousand. They claimed it was to cover any future malpractice suits that might come up from the births she'd attended/assisted. You know what? That's fine. I actually kind of get that one. Here's how it should go down, if I ran the world. You need $20K to cover future suits? Here it is. Only you have to keep it in an interest-earning escrow account and if no suits come up within the statute of limitations (or even 5 years after, because we know how the legal system sometimes works), then Karen gets that money back. With the interest. She was held hostage to this clause for months until she could come up with the $20K and leave town.

Also, did you know that if you have a heart attack while driving and it causes a wreck you probably won't be covered by your car insurance? Most car insurance companies consider that car-wreck-causing heart attack an "Act of God" and they don't cover Acts of God. And you can be damn sure that while your health insurance may cover your body for the heart attack, they ain't coverin' your car. Check it out for yourself!

Awhile back we watched Michael Moore's Sicko movie. We tend to watch all his movies but we watch with a huge grain of salt. Michael Moore is a sensationalist and a propagandist and he tends to get overly dramatic with his way of showing us things. But that doesn't mean what he's showing us isn't true. If you ever want to get good and pissed off, watch a Michael Moore movie.

For me, the most shocking part of the movie was when they interviewed the young woman with Cervical Cancer. Sicko isn't about people without health insurance, although at the beginning, they touch on that. It's an even more frightening movie for focusing on the people getting screwed who have really great health insurance. That young woman? She had excellent (and fully paid up) health insurance. She got Cervical Cancer at age 24. Her insurance company refused her claim saying, "Not possible. Women as young as you don't get Cervical Cancer." Again I say - What. The. Fuck.

I know a lot of really conservative people are harping on the socialism factor of free nationwide medical care but what people don't seem to realize is that a lot of our daily lives are already socialized. I didn't realize either until I watched Sicko. MM points out that having a police force, a fire department, public schools, public libraries - all that is socialism. It's benefits we receive for the taxes we pay.

I'm hoping, as most of us are, that with this new Executive Office, things will get better. I'm also hoping that soon we can find some good, affordable, locally-available-facility insurance.

And on the subject of hope! I hope I win any of a number of fantastic prizes here. She'll be drawing winners in about 2 weeks. Give and give big!

Ever hopeful, Ruth!


Anonymous said...

I have a stack of *those papers* about 6" high from the broken ankle. Auto insurance paid part (because I fell getting out of the car) and health insurance paid the rest, supposedly. Since we switched hospitals BEFORE the surgery in order to have it covered 100%, why are we getting billed for part of it? Who knows...

Nell said...

Yeah... I'm a nurse and I know that there are conditions not covered until the health of the patient actually deteriorates. Ummm.... awesome? So my patient who needs oxygen can't get it covered until he REALLY needs oxygen. So stupid.

Thank goodness my job is not contingent as to what the insurance company will pay for.

Diane said...

The reason you have a stack of papers from the insurance company is because they are obligated under federal law to send you a copy of every claim they process where you could be held financially obligated. Believe me if they didn't have to do that they wouldn't.

5elementknitr said...

Diane, thank you for weighing in! I've always wondered why they send all those papers, now I know!

So my next question is, why don't they wait until they have all the info and just send one paper? We got 12!

Thanks for reading and thanks for the infor!

Tammy said...

Oh jeez. So sorry! Don't even get me started on health insurance. We pay an arm and a leg for lousy insurance. The price increases each year and the benefits decrease. But it's scary to not have it at all.

I just don't trust the govt to handle it either. Talk about paperwork. Ugh. I've been seeing more doctors working out reasonable terms with individuals or families to provide care without the insurance. But there's always the "what if" of needing major hospital care.

Ooops, sorry. See you did it, you got me started. ;)

Karen said...

Hi, I got here from my daughter's blog, Becca over at How Does It End?

my husband and I do not have health insurance. I was laid off after 20 years with the same company. Since I have type II diabetes and he has had cancer, it is imposssible for us to get coverage we can afford. When premiums are $1200 per month, that is more than $14,000 per year. He was in the hospital for 4 days in 2005, and we are paying those medical bills off at the rate of $90 per month, which we can afford to pay.

He is a veteran and signed up for medical care thru them because he can get it, but that still leaves me with no coverage.

here is a link to my blog, a post I wrote about our outrageous experience with insurance and medical bills:

It is insane what people have to go through.

Oh, and did you know that in some states, if you are in an accident, and you have medical insurance, and they pay your hospital bills, then you get a settlement from the place where you had the accident, that the medical insurance can sue you to get their money back??? Even if you paid your premiums? what the fuck is that all about???