With all of the press and media coverage surrounding President Obama's plan for health care reform, I felt compelled to weigh in with my two cents. I will spare you all of the details as I'm sure many of you know of our plight but here are my feelings, as raw as they can be.
Over the past few years, we have had various health insurance providers from a private, specifically negotiated plan to a individually purchased policy. We went from having no medical debt to having debt equal to a year in a public higher education institution. In my eyes, this has happened because hospitals are willing to charge not only for the services provided for the doctor but for the use of the hospital and everything in it. I mean, it is really necessary to charge me $12 for a tube of diaper rash cream and then $63K for a procedure that lasted a whole 30 minutes(yes, we're talking about a shunt surgery here)?
That's not to say that I'm not grateful for the quality care that both myself and my family have received, but must it cost us so dearly?! Should a husband have to work 80+ hours a week? Should a family have to chose between eating or paying the mounting medical bills? Should a medical service provider be able to threaten financial harm to a family despite the fact that this family is doing everything they can to pay their bill on time? Should one have to forgo medical treatment because of the financial impact it will have? Must we live in fear of the "what ifs"...the fear of getting sick?
The way I see it, this shouldn't be allowed to happen in a country that prides itself on being industrialized, modern and forward-thinking. I totally support what President Obama is attempting to do--bring affordable health care to everyone citizen of our country. To end the privatization of health care which has lead to the rising costs and lower standard of care. To make sure that every child born in our country has the equal chance to grow up healthy. To make sure that no one dies because they couldn't afford simple or life-saving treatments or procedures.
For my family, personally, this would relieve us of a huge burden. We wouldn't live in fear of Cara needed a shunt revision or Caitlin needing to visit the ER. Ben & I could get the routine care that we desperately need without having to think about how it will effect our checkbook.
I have to admit that I am a bit naive as to exactly how President Obama plans to accomplish this but from where I stand, thousands of dollars in debt and living paycheck to paycheck, I can't imagine that it could be much worse than this.
One might say that due to the financial gain received from performing top-notch procedures and developing new drugs and treatments, American medicine far out-reaches its socialist counterparts. Without the competition and reward, our standard and expectation of cutting-edge medicine will be diminished. To this, I wonder, why can't the exploration of medicine just be for the betterment of mankind, for the victory over disease, and not for the financial gains or endorsements? We need to return medicine to its core--the want, desire and need to help others. Take away the monetary attachment and replace it with a feeling of charity, pride, empathy--whatever it takes to get people motivated to do something just because, simply put, it's the right thing to do, not because they have something to gain from it.
We have seen socialized medicine work successfully in other modernized countries. Surely, we have something to learn from them. When a tourist in a foreign country can obtain medical services for less than it would cost an American citizen here in this country, something is fundamentally wrong! Granted, no one wants to have to wait 6 months to have an ultrasound or to receive dialysis but no one wants to go into foreclosure on their home because such things cost them their livelihood. We must task ourselves with the job of finding that happy medium, so that it's not just a dream, an agenda but a reality.
I truly believe that our President has our country's best interest and well-being in mind as he approaches both the Congress and the American people with his plan for health care reform. While he may not have the perfect solution, at least he is moving this country, finally, in a direction to forever change the way we think about health care. It is a right, not a privilege! I have seen what the rising cost of health care can do to a family and it has to stop! It is my sincere hope that something is done, and soon, to fix this mess. I want better for my children.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Tuesday, September 08, 2009
Thursday, September 13, 2007
Insurance Blues
For a long time, I've been a supporter of both equal-access public health care and a nationalized health care program for all Americans. I was rallying behind Bill Clinton when he put Hilary in charge of coming up with something economically feasible years ago. Now, faced with my own health care crisis (of the mini-sort), I am wishing that I lived in Canada, Australia or any country that offers free health care to it's citizens. The United States really needs to get on the ball. If we can't have nationalized health care because of the cost and putting the federal government further into the red, than can we at least have a "watch dog" type of organization to ensure fair and equal access to those paying top-dollar for private insurance plans? There are so many injustices and just-plain-wrong things going on that I wish someone was in charge of preventing. What exactly am I referring to, here's the skinny...
I called our insurance company today (Aetna) to ask about a claim that was denied when I truly thought it should have been covered because it was a simple clinic visit and we paid our co-pay at the time of service. So, I call up and speak to a Yolanda who informs me that the claim wasn't processed correctly and that she will re-submit it. I will get a final bill from Aetna after it's been processed again and may have to pay a portion if the $5K deductible hadn't been met prior to this appointment. Good, just what I wanted to hear. True, I wish we didn't have to worry about deductibles and co-pays but that's life. Gone are the days of covering my family members for free, no deductible, cheap co-pays and excellent coverage--only had that once in my life, while working at Baldwin Public Library in Birmingham, MI. There are days when I want that job back, just for the benefits. Anyway, I'm wandering...Next, I dared to ask about our plan's (Aetna Advantage Plus) coverage for physical therapy (PT) since Cara is going to require some to catch up on her milestones. This is where the dam of bad news broke loose. I was informed that our plan doesn't cover ANY (not one ioda, one dime, one session) of physical therapy unless the deductible has been met prior to any PT claims coming through. Now, thankfully, due to the $21K brain surgery and ER visit we have far exceeded our deductible this year so here is what Aetna will graciously cover:
-24 sessions of PT per calendar year
-$25 maximum per session to be paid by insurance
Whoa! Hold the phones, did she say a WHOLE 25 DOLLARS?! Wow, that's so generous. Now, while I have no idea what an average session of PT costs, I can almost bet the ranch that it's more than $25. I mean, when we saw the Nurse Practioner for 10 minutes for Cara's 1 week follow-up, $100 was billed to Aetna. Since physical therapy is a bit more hands on and involved, I just know that $25 isn't going to cut it. So, we're going to be shelling out some serious cash for every session that Cara needs and we will because we are going to everything we can to give her a chance to have the best quality of life--bills be damned.
Now, come next year, when we start all over with the $5K deductible, you have to wonder how in the world we will afford the PT. This question was on my mind too, so I asked Yolanda if there was a plan in existence (with Aetna anyway) that covers more, in terms of PT. She then transferred me to the sales department where I spoke to a gentleman who told me:
1. I couldn't change plans until we had been enrolled, with no policy changes, for 6 months which would bring us to Novemeber of this year.
2. If we wanted to change to a more inclusive policy, we would have to undergo the underwriting process again and Cara's hydrocephalus would be "exposed" and probably wouldn't be covered on the new policy because it would be deemed to be a pre-existing condition.
3. We are stuck with this policy and I just wasted 10 minutes of my time asking about changing.
I thanked him for his time and hung up.
The wheels in my head were turning and I was starting to get pissed off. I mean, what the heck is wrong with insurance in this country if the people who really need it (sick, poor) can't get it because it's either too expensive or because said insurance will not cover the medical condition that they so badly need coverage for? We pay just shy of $300/month for this insurance only to find out just how limited it is. I sometimes wonder why we even bother to pay for it at all except that I wouldn't want to be stuck with a $27K tab. It just bites (in lack of a stronger word to keep this blog at it's "G" rated status) that only the healthy can get good, affordable insurance these days. Yes, it's nice to have so that you don't have to pay for well-child visits and just in case something horrific happens but, when something does happen and heaven forbid, you need some special services, good luck! Hope you have a nest egg hidden under the mattress for such things.
Some would say to me that we should have sprung for a better, more inclusive health care package but, give me a break, who actually sits down, when selecting insurance, and says, "Gee, let's see how the coverage would be if Johnny needs brain surgery or Sally gets cancer." Nobody is that morbid. You get a plan that you can afford that covers the basics and you think life is good. Then your literature for said plan arrives, and you might read the little chart that explains the percentages of coverage and such, but you push it to the back of your mind--you're not going to need to know how much your plan is going to play for orthopedics because you're never going to need it, right? I don't want to go through life thinking about the worse case scencerio every time I purchase something, that's too exhausting.
Since I have discovered our fate due to poor insurance coverage, I've had to try to find funding from other sources, unless, we went to declare bankruptcy next year, which I'd rather avoid. I have a meeting with the financial counseling department at Children's Hospital on the same day that Cara goes in for her PT evaluation. In the meantime, I have to round up 90 days worth of pay stubs, bills and such so that our counselor can determine if we qualify. I have also contacted the county health & human services department to see if the state has any programs that might off-set our medical expenses. Short of having a fund raiser or setting up an account at a bank for donations, which will probably never happen, I'm fresh out of ideas. Of course, there's always payment arrangements, problem is, you have to have money to make those payments and things are already quite tight around the waist right now.
If we had nationalized health care like some other countries, while I may have to wait to receive some services, they would be free. Cara would get the treatments that she needs without us having to worry about affording them. What a wonderful thing that would be! Imagine that, everyone getting the care & services they desperately needed without having to be the next Bill Gates or Donald Trump. We claim to be a land of freedom, equality and opportunity and yet, there's an alarming number of people who an either uninsured or, in our case, under-insured. What's being done to help...not much at all. Some states are better at helping their indigent than others. Colorado just happens to be a pretty lean state in terms of social service programs. Just great!
My point...you just might hear that we've jumped ship and moved to Aussie-land. Move over, Sarah, we're moving in!
**OMGosh, this just might be the longest post I've ever written so, bless your hearts if you take the time to read it!**
I called our insurance company today (Aetna) to ask about a claim that was denied when I truly thought it should have been covered because it was a simple clinic visit and we paid our co-pay at the time of service. So, I call up and speak to a Yolanda who informs me that the claim wasn't processed correctly and that she will re-submit it. I will get a final bill from Aetna after it's been processed again and may have to pay a portion if the $5K deductible hadn't been met prior to this appointment. Good, just what I wanted to hear. True, I wish we didn't have to worry about deductibles and co-pays but that's life. Gone are the days of covering my family members for free, no deductible, cheap co-pays and excellent coverage--only had that once in my life, while working at Baldwin Public Library in Birmingham, MI. There are days when I want that job back, just for the benefits. Anyway, I'm wandering...Next, I dared to ask about our plan's (Aetna Advantage Plus) coverage for physical therapy (PT) since Cara is going to require some to catch up on her milestones. This is where the dam of bad news broke loose. I was informed that our plan doesn't cover ANY (not one ioda, one dime, one session) of physical therapy unless the deductible has been met prior to any PT claims coming through. Now, thankfully, due to the $21K brain surgery and ER visit we have far exceeded our deductible this year so here is what Aetna will graciously cover:
-24 sessions of PT per calendar year
-$25 maximum per session to be paid by insurance
Whoa! Hold the phones, did she say a WHOLE 25 DOLLARS?! Wow, that's so generous. Now, while I have no idea what an average session of PT costs, I can almost bet the ranch that it's more than $25. I mean, when we saw the Nurse Practioner for 10 minutes for Cara's 1 week follow-up, $100 was billed to Aetna. Since physical therapy is a bit more hands on and involved, I just know that $25 isn't going to cut it. So, we're going to be shelling out some serious cash for every session that Cara needs and we will because we are going to everything we can to give her a chance to have the best quality of life--bills be damned.
Now, come next year, when we start all over with the $5K deductible, you have to wonder how in the world we will afford the PT. This question was on my mind too, so I asked Yolanda if there was a plan in existence (with Aetna anyway) that covers more, in terms of PT. She then transferred me to the sales department where I spoke to a gentleman who told me:
1. I couldn't change plans until we had been enrolled, with no policy changes, for 6 months which would bring us to Novemeber of this year.
2. If we wanted to change to a more inclusive policy, we would have to undergo the underwriting process again and Cara's hydrocephalus would be "exposed" and probably wouldn't be covered on the new policy because it would be deemed to be a pre-existing condition.
3. We are stuck with this policy and I just wasted 10 minutes of my time asking about changing.
I thanked him for his time and hung up.
The wheels in my head were turning and I was starting to get pissed off. I mean, what the heck is wrong with insurance in this country if the people who really need it (sick, poor) can't get it because it's either too expensive or because said insurance will not cover the medical condition that they so badly need coverage for? We pay just shy of $300/month for this insurance only to find out just how limited it is. I sometimes wonder why we even bother to pay for it at all except that I wouldn't want to be stuck with a $27K tab. It just bites (in lack of a stronger word to keep this blog at it's "G" rated status) that only the healthy can get good, affordable insurance these days. Yes, it's nice to have so that you don't have to pay for well-child visits and just in case something horrific happens but, when something does happen and heaven forbid, you need some special services, good luck! Hope you have a nest egg hidden under the mattress for such things.
Some would say to me that we should have sprung for a better, more inclusive health care package but, give me a break, who actually sits down, when selecting insurance, and says, "Gee, let's see how the coverage would be if Johnny needs brain surgery or Sally gets cancer." Nobody is that morbid. You get a plan that you can afford that covers the basics and you think life is good. Then your literature for said plan arrives, and you might read the little chart that explains the percentages of coverage and such, but you push it to the back of your mind--you're not going to need to know how much your plan is going to play for orthopedics because you're never going to need it, right? I don't want to go through life thinking about the worse case scencerio every time I purchase something, that's too exhausting.
Since I have discovered our fate due to poor insurance coverage, I've had to try to find funding from other sources, unless, we went to declare bankruptcy next year, which I'd rather avoid. I have a meeting with the financial counseling department at Children's Hospital on the same day that Cara goes in for her PT evaluation. In the meantime, I have to round up 90 days worth of pay stubs, bills and such so that our counselor can determine if we qualify. I have also contacted the county health & human services department to see if the state has any programs that might off-set our medical expenses. Short of having a fund raiser or setting up an account at a bank for donations, which will probably never happen, I'm fresh out of ideas. Of course, there's always payment arrangements, problem is, you have to have money to make those payments and things are already quite tight around the waist right now.
If we had nationalized health care like some other countries, while I may have to wait to receive some services, they would be free. Cara would get the treatments that she needs without us having to worry about affording them. What a wonderful thing that would be! Imagine that, everyone getting the care & services they desperately needed without having to be the next Bill Gates or Donald Trump. We claim to be a land of freedom, equality and opportunity and yet, there's an alarming number of people who an either uninsured or, in our case, under-insured. What's being done to help...not much at all. Some states are better at helping their indigent than others. Colorado just happens to be a pretty lean state in terms of social service programs. Just great!
My point...you just might hear that we've jumped ship and moved to Aussie-land. Move over, Sarah, we're moving in!
**OMGosh, this just might be the longest post I've ever written so, bless your hearts if you take the time to read it!**
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